Bier Block

Your pain specialist has recommended that you receive a Bier Block for the treatment of your pain. This procedure is often used to treat the symptoms of Complex Regional Pain Syndrome (CRPS). The Bier Block interrupts and blocks the cycle of “abnormal” firing of the sympathetic nerves, giving you pain relief. It also attempts to “re-program” the nerves to return to normal behavior. It is thought to deplete the nerve terminals of the neurotransmitters responsible for hyperactivation of these nerves. There are several medications which are used for Bier Blocks, including guanethidine, bretylium, among others. Most of these drugs were formerly used to treat high blood pressure, and are no longer commercially available. Compounding pharmacies may be able to provide your doctor with this medication.

Upon arrival at the surgery center, a nurse will escort you to a room where you will change into a gown before entering the procedure room. This is a special room, kept to the highest standards of cleanliness. To reduce the risk of ‘outside germs’, we request that only our pain center staff accompany you there. An intravenous line (IV) will be started prior to the procedure, and you will be placed on a monitor that will check your blood pressure and heart rate. The IV provides an easy route by which you will receive medication to help you relax and make the procedure as comfortable as possible. You will not be ‘put to sleep’, and you will be able to respond and move if the doctor or nurse asks you to. It is rare for any of my patients to experience significant pain during the procedure, and every effort is made to ensure your comfort.

A tourniquet is applied to the affected limb, and a small intravenous catheter is placed into the hand or foot, depending on the limb involved. The medication is injected into the catheter after the tourniquet is tightened, and the medication stays in your limb for approximately 30 minutes, to allow it time to bind to the tissues. The tourniquet is then deflated. There can be a temporary drop in blood pressure and some dizziness when the tourniquet is deflated. You are monitored in the procedure room until these symptoms have normalized.

You will need to stay approximately 30 minutes in the recovery room following the procedure. The medication you received to help you relax will wear off very quickly. The total time you will be at the center is approximately 90 minutes. The nurse will tell you what to expect and how to take care of yourself after you return home. You will also receive these instructions in writing. For safety reasons, we request that you do not drive yourself home.