title: Safety and effectiveness of intravenous regional anesthesia (Bier block) for outpatient management of forearm trauma.
abstract: OBJECTIVE
  To assess the safety and effectiveness of intravenous regional anesthesia (Bier block) in the management of forearm injuries (i.e., forearm, wrist or hand) by primary care physicians at a diagnostic and treatment facility.
  
  
  METHODS
  A retrospective review was conducted of all patients at a single centre who underwent a Bier block for forearm injuries between September 2000 and March 2005.
  
  
  RESULTS
  1816 Bier blocks were performed on 1804 patients (64% male) during the study period. Patient age ranged from 4-70 (mean 25) years. Wrist fractures requiring reduction were the most common diagnosis. Adverse events were recorded in 9 cases (0.50%, 95% confidence interval 0.23%-0.94%): 1 case of medication error (0.06%); 3 of improper cuff inflation (0.17%); and 5 of inadequate analgesia (0.28%). None of the adverse events resulted in failure to complete the procedure or in serious morbidity or mortality.
  
  
  CONCLUSIONS
  Bier block anesthesia is a safe, effective and reliable technique in an outpatient primary care setting. This technique is a useful modality for physicians who manage acute upper-extremity injuries.
authors.affiliation: Whistler Health Care Centre, Whistler, British Columbia, Canada. bruce.mohr@vch.ca
authors.forename: Bruce
authors.initials: B
authors.lastname: Mohr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000779:Anesthetics, Local / Q000627:therapeutic use; D001134:Arm Injuries / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D011320:Primary Health Care; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine