Intravenous regional anesthesia

A method of anesthesia involving intravenous injection

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Intravenous regional anesthesia (IVRA), also known as Bier block, is a method of anesthesia that involves the intravenous injection of a local anesthetic into a limb that has been isolated from the rest of the circulation by a tourniquet. This technique is primarily used for short surgical procedures on the extremities.

History

The technique was first described by the German surgeon August Bier in 1908. Bier's method involved the use of a tourniquet to occlude blood flow to the limb, followed by the injection of a local anesthetic into the venous system of the isolated limb.

Procedure

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 ensure complete occlusion of blood flow. A local anesthetic, such as lidocaine, is then injected into a vein in the isolated limb. The anesthetic diffuses into the surrounding tissues, providing anesthesia to the entire limb.

Indications

IVRA is indicated for short surgical procedures on the extremities, such as carpal tunnel release, ganglion cyst excision, and fracture reduction. It is particularly useful for procedures that are expected to last less than 60 minutes.

Advantages

• Rapid onset of anesthesia
• Minimal systemic absorption of the anesthetic
• Easy to administer

Disadvantages

• Risk of tourniquet pain if the procedure is prolonged
• Potential for local anesthetic toxicity if the tourniquet fails
• Limited to procedures on the extremities

Complications

Complications of IVRA can include tourniquet pain, local anesthetic toxicity, and nerve injury. Proper technique and monitoring are essential to minimize these risks.

See also

• Regional anesthesia
• Local anesthetic
• Peripheral nerve block

External links

• Wikimd: Intravenous Regional Anesthesia