Intravenous regional anesthesia

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(Redirected from Bier block)

August Bier
File:LimbProtectionSleeve.jpg
LimbProtectionSleeve

Intravenous regional anesthesia (IVRA), also known as a Bier block, is a technique of regional anesthesia used to anesthetize a limb. It is commonly used for short surgical procedures on the extremities, such as hand surgery or foot surgery.

History[edit | edit source]

The technique was first described by the German surgeon August Bier in 1908. Bier's method involved the use of a tourniquet to isolate the limb's blood supply and the injection of a local anesthetic into the venous system of the limb.

Procedure[edit | edit source]

The procedure begins with the application of a tourniquet to the limb to be anesthetized. The tourniquet is inflated to a pressure higher than the patient's systolic blood pressure to occlude blood flow. A local anesthetic, such as lidocaine, is then injected into a vein in the limb. The anesthetic diffuses into the surrounding tissues, providing anesthesia to the entire limb.

Steps[edit | edit source]

1. Preparation: The limb is exsanguinated, typically using an Esmarch bandage. 2. Tourniquet application: A double tourniquet is often used, with the proximal cuff inflated first. 3. Anesthetic injection: The local anesthetic is injected into a peripheral vein. 4. Procedure: The surgical or diagnostic procedure is performed. 5. Tourniquet deflation: The tourniquet is deflated slowly to prevent a rapid washout of the anesthetic into the systemic circulation.

Indications[edit | edit source]

IVRA is indicated for procedures on the extremities that are expected to last less than 60 minutes. Common indications include:

Contraindications[edit | edit source]

Contraindications for IVRA include:

Complications[edit | edit source]

While generally safe, IVRA can have complications, including:

Advantages[edit | edit source]

IVRA offers several advantages:

  • Rapid onset of anesthesia
  • Minimal equipment required
  • Good muscle relaxation
  • Reduced need for postoperative analgesia

Disadvantages[edit | edit source]

Disadvantages include:

  • Limited duration of anesthesia
  • Potential for systemic toxicity
  • Tourniquet-related complications

Related Pages[edit | edit source]

References[edit | edit source]

External Links[edit | edit source]


Contributors: Prab R. Tumpati, MD