Intravenous regional anesthesia

August Bier

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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

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

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

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

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

• Carpal tunnel release
• Ganglion cyst excision
• Fracture reduction
• Tendon repair

Contraindications

Contraindications for IVRA include:

• Severe peripheral vascular disease
• Sickle cell disease
• Raynaud's phenomenon
• Allergy to local anesthetics

Complications

While generally safe, IVRA can have complications, including:

• Local anesthetic systemic toxicity (LAST)
• Tourniquet pain
• Nerve injury
• Compartment syndrome

Advantages

IVRA offers several advantages:

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

Disadvantages

Disadvantages include:

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

Related Pages

• Regional anesthesia
• Local anesthetic
• Tourniquet
• Peripheral nerve block
• Hand surgery
• Foot surgery