Comparison of Bier's Block and Systemic Analgesia for Upper Extremity Procedures: a Randomized Clinical Trial

Abstract

Background: There are three methods for procedural sedation in upper extremity traumas; systemic, regional and local anesthesia. There is controversy in the literature regarding the method of choice for this purpose. Objectives: The aim of this study was to compare conscious sedation and Bier’s block methods for pain reduction in upper extremity trauma patients. Patients and Methods: This was a non-blinded randomized clinical trial. Patients were randomly allocated to either the Bier’s block or the conscious sedation group. Pain reduction was assessed by a numerical rating scale; patients, surgeons and physicians responsible for analgesia satisfaction were assessed using a five-point Likert scale. Results: There were no significant differences between the two groups regarding basic characteristics. Pain reduction was significantly more in Bier’s block group (P = 0.09). The most common complication in patients of the Bier group was pain in the tourniquet site (6 cases; 17.65%) and in the conscious sedation group this was nausea (11cases; 31.43%). The total number of cases with complications did not significantly differ between the two groups (P = 0.35). Surgeons' satisfaction was similar between the two groups yet satisfaction of patients and physicians, responsible for analgesia, was more in Bier’s block group (P = 0.1 and P = 0.05, respectively). Although the amount of time needed for inducing sedation was more in the Bier group yet total duration of procedure in the Bier group was significantly lower than the conscious sedation group (P < 0.01). Decline in pulse rate and mean arterial pressure was more intense in the conscious sedation group indicating more hemodynamic instability (P < 0.01). Conclusions: Regarding our results, it seems that Bier’s block works better for procedural sedation in upper extremity traumas compared to conscious sedation, when used appropriately for selected cases.