Bier block?
 

My dr said there's no point in doing more symoathetic blocks because I've had minimal relief. She wants to try a bier block. Anyone have experience with these?

On a side note i told the pain dr that my ot thinks I have an injury to my scaphoid ligament and asked if she got the chart notes requesting an Mri. She pretty much said that she and the hand specialist knew what they were seeing and a mri would be a waste of time?? I got frustrated and little tears came to my eyes and I said that I really wasn't content with an rsd diagnosis cause I don't want to think I have some forever thing (she just got done telling me there was little more they could do) when there is a question about an injury and my bone scan disnt show soft tissue so how could they know?

So she said she would read the notes and think on it. But we needed to do the bier block first.
Just wanted to hear some experiences of what this is like. Kind of scares me as I've had a interscalene block get into my blood stream and it was a horrible experience. And this is intentionally injecting anesthetic into my blood stream? Can they be sure the tournicate is efficient in preventing that?

Sorry I don't know but I too am curious for the answer.

What is in an inter scalene and bier block? How did the inter scalene get into ur bloodstream?

hi jenn. i'm sorry but i've never heard of a bier block. i've heard of sympathetic nerve blocks though. i had eight of them and they helped a little but not much. but everyone's different. i hope that you feel some pain relief soon. soft hugs.

An interscalene block is done into the never to your arm and shoulder and it's done near your colar bone. I had it done before having shoulder surgery and it deadens your arm so after surgery you have no pain but can't feel your arm. They missed the nerve and injected it into my blood stream. It made my heart tachycardic and they had to give me meds to slow my heart.

A bier block is done by draining an extremity of blood flow and injecting something like lidocaine and other meds intervieniously into that area. Its said to calm the nerve. From what I read they do the tournicate to keep the anesthetic from flowing into the rest of your body and to keep the blood flow from the area they are injecting.

Hi Jennijojo,

I am just in from a late flight so will keep it short.

IVRSB - IV regional sympathetic blockade is stated in the new revision of the Dutch Protocol for CRPS treatment as "having no place in the treatment of CRPS 1"

I don't recall seeing it really mentioned anywhere as a treatment of choice, some of the studies indicate no benefit. It sounds horribly unpleasant.

Bier developed this type of anesthesia in 1908. I am hoping we made some progress since then. There's ketamine to try or Calmare or the neridronate trial. Stanford just started a trial on LDN. You aren't out of options.

IMHO, it may be time to consider other doctors if the ones you have can't come up with anything better than this and telling you there's no point in imaging. Even if all it does is put your mind at ease over your diagnosis I think that has value. Stick to your guns girl, it ain't over yet! :cool:

Songbird,

I came here today to say exactly what you said
. I too have been having an increase in pain and total frustration with all that comes with it! I have been wondering why I bother continuing to choose to live this way. I always thought life was about having a family, teaching your children to be great and kind, traveling and learning about the world ....

But I will never have any of those things! I worked hard to get through nursing with a 3.8. I went to work as a cardiac nurse... Things were coming together. I had a five year plan. If finish school, try to have a baby ( at 40+)...and knew o could finally afford to adopt if I needed to... Buy my first home... But I fractured my foot at work and since then life has come crashing down around me. I will never experienced all the things I always thought made the struggles of life worth it.

I just don't know how or why I choose to continue to live in this pain and everything that comes with it.

I'm sorry I don't have much positive to say, except... You do have your daughter and it is important to be strong for her.

Velkyn,

I am a nurse too and was also hurt at work. RSD is a horrible condition, but Workman's Comp is living hell. I feel for you as my five year plan was crushed too.

As far as a Bier block, I believe they usually use a blood pressure cuff as a tourniquet. I haven't read anything supporting the use of a bier block to treat CRPS, but putting a tourniquet on a CRPS limb does not sound like a good idea.

I encourage you to keep searching for a good PM doc. I'm on my 4th one and finally found someone who really knows CRPS and can think outside of the box. I have done several brachial plexus blocks and they really have helped.

Hi,
I've had RSD since I was 16, so for 13 years now. Bier blocks were one of the first nerve block treatments my anesthesiologist started with. I have it in my right limbs. It looks as though someone above has explained the method. We used a triple valve tourniquet so that the blood is slowly released back into the limb. It must be mixed back in with the medication cocktail slowly because there is a risk of seizure. I used to have these weekly. The first one have me near complete pain relief for 2 hours, and each one gave me a little more. I think the longest I was pain free was 11 hours, and that was the 17th block within a few months but we had to stop because I was only 16 and the doctors said I had reached my limit for how many times I could be put under general anesthesia within a year without causing brain damage.
The nerve blocks I do now are better because I am awake (more uncomfortable) and though I don't get complete pain relief they last much longer and I can have them without the stress of being put under.
I hope that helps!


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Have you discussed trying a brachial plexus block instead of Bier block? You don't need to be under anesthesia for a brachial plexus block, and they're not really painful to have (very quick).

I have had more than 10 stellate ganglion blocks. While those were helpful, once I switched PMs and he tried a series of brachial plexus blocks my pain decreased dramatically. I was able to go off of all of my long acting opiods and now just use short acting when needed.

Thanks guys for the info! I won't be under anesthesia. And if I want sedation I have to ask. I have it tomorrow and was informed today they would be putting the iv right in the area the pain originates from (my thumb ends up the area that hurts worst on really bad days but the crps is said to be in my wrist)
Not to thrilled about this.
The dr informed me if I wanted to apply for short term disability to be retrained for a new career I had to try everything.

What's weird is she's anti med. She said there is an antidepressant used to treat pain but she doesn't like to start there. And pain meds, she said im too young (almost 40) because she thinks this is going to go on forever I guess....but I'm about at the max gaba dose now. Helped for a couple weeks and now it's starting to be less effective.
My ot told me the hardening of the tendons and weakness of ligaments are likely an underlying cause or part of the crps destruction so my hope of not having crps is kinda dashed. He said he too thinks I have it.
I simply can't live with this pain always. It's devistating. I do have good days where i use my hand more but the following days are horrible. I'm so tired of this. I don't care if it's crps or what I just want to feel better. Willing to try anything.

BUT everything I've read sounds like there is no point in this bier block. Everything they do they keep talking about resetting the nerve/pain response. Well my brain doesn't seem to be falling for it. As far as plexus block, is this like an interscalene? I wouldn't care if they deadened my arm every week...actually that would be amazing.

Sorry so long, I have had some improvements over the course of these treatments. I don't get blue hand very often. Temp stays pretty normal, most of the time (unless I carry my hand at my side) and my color as a whole is a wee bit better..still have swelling and flaming red areas. But the thing that im most bummed about is the pain hasn't changed :(

Wish my luck tomorrow! :) im telling my brain to listen! Lol

Hi Jennijojo,

You are going to do fine. Sounds like one of those hoops you have to jump through.

So I looked into the Bier block a bit further than the Dutch Protocol and I found this encouraging article from the Journal of Hand Surgery, European edition 2011.

http://www.ncbi.nlm.nih.gov/pubmed/21719518

Is your doc using methylprednisone along with the lidocaine? 88% in this study experienced relief and at five years out 92% were pain free. I don't know who ran the study or if it excluded any other treatments. Its nice to see something encouraging though.


Let us know how you do. I am sending thoughts of healing and a comfortable procedure.
:hug::hug::hug:

I can't have any more steroid. The last round of 3 in a month was too much. Had some issues. So I'm asking for no more. The neuro surgeon who did my back repair had methyl prednisone listed as an allergy cause I went kinda nutty after so many in my back. But I'm not allergic and told them I would give it a try. In the last twelve months inhave had 7 steroid injections. Lol so im worried to have any more. I have issues with adrenaline regulation with them sometimes. That's what happened last month. It's kinda hard to wait it out feeling like you're gonna go crazy lol but I have been told that most people who are actually going insane aren't aware it's happening ;)
Thanks for sending your hopes., im going to be so very hopeful! I will update tomorrow! :hug:

I had the bier block today. They didn't tell me they put ketamine in the solution in my arm...im a little fuzzy as on top of iv ketamine I had 6mgs of versed. When they released the cuff all the meds pooled in my lower arm rushed to my brain and weird stuff happened.they kept saying to give me more versed so I wouldn't remember. I'm not sure if it was the ketamine or the steroid or the lidocaine, but I couldn't hear,my limbs and head were flailing and I couldn't control it. I couldn't open my eyes yet was seeing amazing and crazy stuff..the nurses and drs talked me through and I woke up 3 hours later. Kinda seemed like they weren't surprised by what Happened...
It remains in my head a little but not as a terribly scary thing. I have some relief in my hand but where the iv went in that hand still hurts and the nerve up my forearm.

Wish it would have stayed numb! Well keep your fingers crossed for me, dr said it could take a bit to get true idea of if it really helped.

Is this normal or weird lol?

Sounds like you had a heck of a day! I don't know if that is weird or normal. My ketamine with versed is not terribly weird but then again I am getting it dripped in slowly.

Hope you get some upcoming relief! :hug:

Right now I'm at a 2 for pain. I was a 7-8 yesterday! The iv site and the missed iv site in that hand are sore but so far so good. Lol I saw trees growing out of Playdoh. Well my brain was sending those images cause I would t open my eyes.
I have no opinion any more whether that experience was good or bad lol thanks versed!
I'm so hoping it stays like this!

When you have an infusion (I found out today they do them at my pms office)
Do you have any psychological or out of body effects? I don't know if it was the dose all at once Ot the mix of that and lidocaine getting through my system. I read the lidocaine can have nasty effects of its own in your blood stream.

I think I would have lost it if it wasn't for the other meds they were pushing and the dr oh so sweetly walking me through my tripping out lol

Hi Jennijojo,

Hard to know which med you reacted and responded to. I do well on the ketamine with versed. They put a little zofran in for nausea which is my biggest side effect. I tend to be urpy, never outgrew motion sickness, etc.

So far I just get swirly colors behind my eyes. I keep them closed because the blurry double vision many get during the infusion is not to my liking. I listen to peaceful music and just chill out. Same day I take a nice long nap and dont drive till the following morning. No afteraffects to date. I am little and not real tolerant of meds but it hasn't been difficult.

My dose was built up from 0.5 mg per kg to 0.75, next time we go to 1mg, the max dose he gives. I go every two weeks for 4 more sessions, then have boosters. If I dont like the higher dose I will go back down because I get benefit at the mid level. My next infusion is this Friday, my schdule got delayed since they are booked. I will post an update to my ketamine thread a few days after.

Keep in mind effects are cumulative and not earth shattering for most people. It takes a while to build. If you go for it try more than one before making a judgement.

So glad you got some relief! :hug:

Next time I think I would do better with an infused dose rather than boom all at once. Thing is I didn't even know he put ketamine into the mixture until he was putting it in.
I giggle now hearing the nurses say "is she having a seizure? What's going on?" And the doc says "it makes you feel like you're on another planet" lol so very true. I think infusion would be best for me. I'm not one who likes to lose control of my mind like that! I will talk to them next visit and see what they have to say. Reading that study I didn't see whether that 5 year improvement time frame was with one block or regular bier blocks? So I'm curious what is in store for me but at least I know this dr has other tricks up his sleeve vs how his p.a talked at my last appointment!