Expert: Ronald Levy, M.D. - 12/29/2009

Question
Dear Dr. Levy:
I have two questions regarding sedation for Bier Block.
I was offered an option of just getting propofol vs. combination of versed/fentanyl/propofol for sedation for Bier Block.
1. What are the advantages of getting the versed/fentanyl/propofol combination over propofol alone, if any?
2. Is one of the advantages of giving versed/fentanyl along with propofol, the fact that versed/fentanyl reduces the dose requirement for propofol (I read this somewhere), eventually resulting in the patient receiving less total anesthetics than if propofol was used alone?
Thank you for your help in advance.

Answer
There are several reasons for multimodal treatments. The first is (as you say) it reduces the amount of Propofol) but more importantly, these drugs have other useful effects. The Versed is an anxiolytic and also an amnestic. The Fentanyl is a pain killer. When you get a Bier block, the need to put two blood pressure cuffs on your arm and keep them inflated at high pressure for the case. That can get painful after a short while and these drugs help reduce that discomfort.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston