Bupivicaine toxicity and bier blocks

The case report and careful work of Rosenberg and co-workers substantiates the concern workers in the United Kingdom have felt regarding the use of bupivicaine for Bier block. Your readership should be aware that in the period 1979 to date, seven patients have died in the United Kingdom as a result of Bier blocks in which bupivicaine was used. Although full details are not available, in some cases at least, it appears to that recommended drug dosages (1.5 ml/kg as an 0.2% solution) was used and that early cuff deflation was not solution) was used and that early cuff deflation was not a factor. The Council of the Association of Anaesthetists of Great Britain and Ireland has requested the Committee on Safety of Medicines to consider appropriate action to prevent the use of bupivicaine for this technique.