are risks to this procedure, including seizures, coma, confusion, and cardiac arrest, if the child were to unintentionally receive a massive amount of lidocaine rapidly Three randomly controlled trials involving Bier blocks found no adverse effects among more than 500 procedures Still some physicians prefer to perform the Bier block or mini-Bier block in the operating room, where circumstances can be better controlled NONPHARMACOLOGIC METHODS FOR PAIN CONTROL Regardless of the procedure performed or the medications used during PSA, the patient’s developmental level and acute level of anxiety will directly impact the success of a procedure and the patient’s experience There are many nonpharmacologic methods to decrease the child’s fear and incorporate the family into achieving the therapeutic objectives In general, these methods are low cost, consume very little time, and have few, if any, side effects Thus, nonpharmacologic techniques can be used alone or as adjuncts to sedation and analgesic drug therapy Children need gentle reassurance and carefully chosen words to reduce fear and pain One should keep in mind that young children understand more than they say Avoid casual teasing, condescension, or talking about the child while excluding him or her As many choices as possible should be offered, but only if they are real choices Do not tell a child that something will not hurt unless you are sure that it will not It is important to be honest with the child about any pain or discomfort that he or she will experience Once a child is surprised by a painful stimulus, he or she will become more vigilant and less amenable to distraction or relaxation techniques In general, the time between informing the child about potential discomfort and the actual procedure performance should be brief Long delays between the explanation and the actual procedure increase anticipatory distress prior to the procedure One study showed that an empathic (age-appropriate) explanation of an upcoming needle stick reduced crying among patients compared with a group of children who received impersonal instructions Allowing an older child to read about a procedure and then allowing roleplaying and discussion was helpful in reducing pulse rates, as well as other physiologic and behavioral responses to pain Such explanations and roleplaying are time-consuming, and it is helpful to enlist the child’s parents to assist in these techniques