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Prilocaine for Bier's block: how safe is safe?
1Accident and Emergency Department, Leeds General Infirmary, U.K.
Archives of Emergency Medicine
|September 1, 1990
Summary
Prilocaine is a safe choice for Bier's block (intravenous regional anaesthesia), with no serious complications reported in approximately 45,000 procedures. Adhering to guidelines ensures the safety of this widely used anaesthetic technique.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Prilocaine is the preferred agent for Bier's block since 1983.
- Bupivacaine's license withdrawal for IVRA due to severe complications.
- Prilocaine has a long safety record since 1964.
Purpose of the Study:
- To evaluate the safety and efficacy of prilocaine in intravenous regional anaesthesia (IVRA).
- To assess the incidence of complications associated with prilocaine use in Bier's blocks.
- To provide evidence supporting the continued use of prilocaine in IVRA.
Main Methods:
- Review of existing literature on prilocaine in IVRA.
- Conducted a UK-based survey of prilocaine usage in Bier's blocks.
- Analysis of reported complications, including accidental cuff deflation.
Main Results:
- Approximately 45,000 Bier's blocks performed with prilocaine in the UK.
- No documented cases of convulsions, arrhythmias, or fatalities related to prilocaine in IVRA.
- No deaths recorded by the Committee for Safety of Medicines over 25 years for prilocaine (including other regional anaesthesia).
Conclusions:
- Intravenous regional anaesthesia using prilocaine is a safe technique.
- Fatalities are highly unlikely if current guidelines are followed.
- No restriction needed for use by trained anaesthetists, provided a strict protocol is adhered to.