Regional Anesthesia Biers Block

This technique relies on using the vasculature to bring the local anesthetic solution to the nerve trunks and endings. In this technique, an extremity is exsanguinated with an Esmarch (elastic) bandage, and a proximally located tourniquet is inflated to 100 to 150 mm Hg above the systolic blood pressure. The Esmarch bandage is removed, and the local anesthetic is injected into a previously cannulated vein. Typically, complete anesthesia of the limb ensues within 5 to 10 min. 

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Local anesthetics are used to locally anesthetize a wide range of specific body parts or areas to allow painless surgery. Local anesthetics are most commonly used for dental procedures and repair of lacerations. They can also be used to provide neural blockade for larger, more painful procedures. Sites of LA application include localized injection, peripheral nerve blocks as well as central nerve blockade. The only safe agents which can be utilized for intravenous regional anesthesia (Bier block) are lidocaine and prilocaine. Other typical indications are outlined in Table 64.1. 

Guay J. Adverse events associated with intravenous regional anesthesia (Bier block) a systematic review of complications. J Clin Anesth 2009 21(8) 585-94. 

Absolute bupivacaine is contraindicated for IV regional anesthesia (IVRA, Bier block) because of the potential risk of tourniquet failure and systemic absorption of a toxic volume of the drug. Bupivacaine is contraindicated in obstetrical paracervical block anesthesia as its use in this technique has resulted in... 

In a review of the literature on adverse events associated with intravenous regional anesthesia the author concluded that Bier s block is safe when anesthetic doses are kept low [46 ]. Seizures have been reported at doses as low as 1.4 mg/kg of hdocaine, 4 mg/kg of prilocaine, and 1.6 mg/kg of bupivacaine. Serious cardiac events have only been reported with hdocaine and bupivacaine. 

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