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Bier's Block (Intravenous Regional Anesthesia)

Bier's block, also known as intravenous regional anesthesia (IVRA), involves injecting local anesthetic into a limb that has been isolated with a tourniquet. This provides short-term anesthesia for surgeries lasting 45-60 minutes on an extremity. The key steps are establishing an IV, injecting lidocaine or prilocaine near the surgical site after the tourniquet is inflated, then deflating after surgery. Complications can include local anesthetic systemic toxicity if the tourniquet malfunctions, but it is otherwise a safe and cost-effective form of regional anesthesia where the patient remains awake.

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Mahrukh Siddiqui
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275 views11 pages

Bier's Block (Intravenous Regional Anesthesia)

Bier's block, also known as intravenous regional anesthesia (IVRA), involves injecting local anesthetic into a limb that has been isolated with a tourniquet. This provides short-term anesthesia for surgeries lasting 45-60 minutes on an extremity. The key steps are establishing an IV, injecting lidocaine or prilocaine near the surgical site after the tourniquet is inflated, then deflating after surgery. Complications can include local anesthetic systemic toxicity if the tourniquet malfunctions, but it is otherwise a safe and cost-effective form of regional anesthesia where the patient remains awake.

Uploaded by

Mahrukh Siddiqui
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Bier’s Block

(Intravenous
Regional Anesthesia)
By Urooba and Fatima
BS Anaesthsia and critical care
What is Bier’s Block?
• The Bier block, also known as intravenous local anesthesia
(IVRA), is a safe, effective, and cost-efficient way to provide
short-term anesthesia and analgesia during surgery on an
extremity.
• A Bier block is a form of regional anaesthesia, where local
anaesthetic is given intravenously with a tourniquet applied to
stop it from spreading systemically.
• It provide surgical anesthesia for relatively short (45-60min)
surgical procedures on an extremity (eg: carpal tunnel release)
Indications
• Indications include any procedure on the arm or leg that
requires operating anaesthesia, muscle relaxation, or a
bloodless field. IVRA is commonly used for extremity surgery,
such as carpal tunnel surgery or tendon repair.
• Reduction of fractures and dislocations
• Repair of major lacerations
• Removal of foreign bodies
• Debridement of burns, and drainage of infection.
Equipment
• The technique requires minimal additional equipment and can
be performed in a variety of clinical environments.
• Local anesthetic agents: lidocaine (0.25%–0.1% ) (alternative is
prilocaine, 0.5%)
• One rubber tourniquet
• One 20- or 22-gauge intravenous extracatheter (catheter over
needle)
• One 500-mL or 1-L bag of intravenous solution connected to
an infusion set to be connected to the intravenous cannula to
maintain its patency until the anesthetic solution is injected in
the isolated extremity
• Two pneumatic tourniquets of appropriate size for the
selected extremity
• One Esmarch bandage for exsanguinating.
Technique
• Establish an intravenous (IV) line in the uninvolved extremity/
• Draw up and dilute 1% plain Lignocaine (1.5- to 3-mg/kg total
Lignocaine dose) for a final concentration of 0.5% Lignocaine.
• Place a padded tourniquet and inflate the upper cuff.
• Insert a small IV cannula near the pathological lesion and secure it.
• Deflate the tourniquet.
• Elevate and exsanguinate the extremity.
• Inflate the tourniquet (250 mmHg) and lower the extremity.
• Inflate the proximal cuff only, if a double-cuff system is used.
• Infuse the anaesthetic solution.
• Remove the infusion needle and tape the site.
• Perform the procedure.
• If pain is produced by the tourniquet, inflate the distal cuff first, and
then deflate the proximal cuff.
• Do not deflate the cuff if total tourniquet time is less than 30 minutes.
• Observe 45 to 60 minutes for possible reactions.
Contraindication
• Absolute contraindications include;
• Patient refusal
• Hypersensitivity or allergy to local anesthetics
• Impaired perfusion of the limb
• Deep vein thrombosis or thrombophlebitis of the limb
• Uncontrolled hypertension
• Relative contraindications include;
• an uncooperative patient
• Obesity impacting the reliability of the blood pressure cuff on
large extremities
• Neuropathies
• Arrhythmias
• Sickle cell disease.
Complications
• Severe adverse effects include local anesthetic systemic
toxicity (LAST)
• Seizures
• Cardiac arrest.
• Less severe complications include the potential for nerve
damage
• Compartment syndrome
• Skin discoloration
• The most common adverse event encountered during IVRA is
tourniquet pain.
Advantages of Bier block
• Easy to administer
• Low incidence of block failure
• Safe and cost effective
• Rapid onset and recovery
• Controllable extent of anesthesia
• Patient awake during the procedure
Drug of choice
• Prilocaine
• It is the drug of choice as it is least toxic and has the largest
therapeutic index.
• Onset: 2-15minutes
• Duration: 1-4hours
• Lignocaine
• Acceptable alternative
• Onset: 1.5-5minutes
• Duration: 1-4Hours
• Bupivicaine
• It is not suitable for Bier’s block because of its toxicity and
slower onset.

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