Calcium Bier Block Technique

Ensure patient attached to cardiac monitoring

Insert an IV catheter into dorsum of the affected hand.

Ensure IV catheter also in opposite hand

Elevate the limb and drain the superficial veins of the arm

Apply a double-cuffed pneumatic tourniquet above the elbow

Inflated cuff to 100 mm Hg above systolic blood pressure.

Infuse 10 to 15 mL of 10% calcium gluconate plus 30 mL normal saline (DO NOT use calcium chloride in view of its increased risk of tissue toxicity)

Maintain ischaemia for 25 minutes

Then sequentially release the cuff over 3 to 5 minutes.

Pain relief should be evident within 30 minutes of cuff release.