Bier Block
The doctor has recommended that you receive a Bier Block for the treatment of your pain. This procedure is often used to treat the symptoms of Reflex Sympathetic Dystrophy (R.S.D.), recently renamed Complex Regional Pain Syndrome (C.R.P.S.). This is a complex disorder which presents with pain and often, sensory abnormalities. The nerves commonly involved are the sympathetic nerves. The sympathetic nerves are part of our sympathetic nervous system, which is responsible for perception of some types of pain sensation. It also plays a major role in the regulation of blood flow, degree of sweating and temperature sensation. In this pain syndrome the nerves begin to “over-fire” and send abnormal signals (for example: swelling, skin color, and temperature changes). The Bier Block interrupts and blocks the cycle of “abnormal” firing, giving you pain relief. It also attempts to “re-program” the nerves to return to normal behavior.
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.
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.
Post Procedure Symptoms
Pain Relief – The local anesthetic may cause some temporary numbness in the painful limb, this will also give you pain relief. If you experience numbness, the nurse may advise you on safety precautions. The steroid medicine helps to decrease swelling and inflammation. It may take 2-3 days before the steroid medicine starts to work, and 3-10 days before the full benefits of the steroid medicine become apparent. The combination of the three medicines needs time to work before the overall benefits become apparent. If you need to use your pain medicine it is okay to do so.
Possible Symptoms
Light-headedness – May occur for a day or so. Avoid exercise or flights of stairs for 24 hours.
Sense of fatigue – Energy level may seem lower than normal for 24-48 hours.
Changes to the degree of swelling of the painful limb – May temporarily increase or decrease.
Changes in the skin color or skin temperature of the painful limb – May temporarily occur. Remember, it is your sympathetic nervous system that regulates blood flow and skin temperature changes.
Local tenderness at the medication injection site – This is normal and will pass within a few days.
Facial flushing – This is a side effect of the steroid and will pass within a few days. This rarely accompanies a fever. Check your temperature. If it is above 101 please report this to the doctor’s office.
Acne – Occasionally acne may temporarily worsen for a few days. This is a side effect of the steroid.
Indigestion – This is a side effect of the steroid and may last a few days. Try to eat small frequent meals. Avoid highly spicy, rich foods during this time. Over the counter antacid medication often relieves this symptom. Occasionally nausea may occur on the day of the procedure. Make sure to follow the post procedure instructions given to you by the nurse. If nausea, vomiting, or indigestion becomes persistent, please call the doctors office.
Insomnia – This is a side effect of the steroid and may last a few nights. A warm beverage and a relaxation routine (listening to music, relaxation tapes) all help to aid a restful nights sleep.
Useful information to report to the doctor at your next visit
- How much of the pain was relieved after the injection?
- How long did your pain relief last?
- Was there any change in the type of pain you experience? e.g. Shooting? Aching? Burning?
- Did you experience any side effects?
- Has your ability to perform activities improved?
Be sure to take your medicine(s) as the doctor orders, especially if there are any new medicines prescribed on the day of the procedure.
The nurse will attempt to contact you by phone a few days after your procedure to ask you how you are doing.
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