The role of ischaemia in the analgesia which follows Bier's block technique

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Abstract
Of the median nerve; the latter stimulus was also used to provoke the SP. After 28 min of tourniquet ischaemia, the electrical stimulus failed to provoke the SP and bilateral SSR, indicating blockade of the afferent limb of the reflex. The acoustic SSR was unaffected by ischaemia, and thus the efferent limb of the SSR was not blocked, indicating that ischaemia does not affect the post-ganglionic efferent C fibres. These findings confirm that 30 min of ischaemia blocks Aβ afferent fibres but does not block efferent C fibres. Thus the analgesia following Bier's block alone, in some patients with sympathetically maintained pain, most likely results from the ischaemic blockade of sensory Aβ fibres, confirmed both acoustically and by electrical stimulation of the median nerve. ∗Correspondance to: Michelangelo Buonocore, Oxford Regional Pain Relief Unit, Churchill Hospital, Oxford OX3 7LJ, UK. (Received 12 March 1991; revised 10 February 1992; accepted 12 February 1992.) © Lippincott-Raven Publishers....
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