Bier Block Anesthesia, Procedure, Dose, Technique, Risks, Dose

The Bier block, sometimes called intravenous regional anesthesia (IVRA), is a procedure in which the venous system of an exsanguinated extremity is injected with a local anesthetic, and then the tourniquet is applied to restrict the blood flow. It is administered during procedures involving the extremities, such as carpal tunnel release, to provide anesthesia and analgesia for brief durations, typically less than one hour. The Bier block delivers analgesia, muscle relaxation, and a surgical field that is mostly bloodless.

Bier Block Anesthesia

Regional anesthesia for surgical procedures in a specific limb is achieved with Bier block anesthesia, which is also referred to as intravenous regional anesthesia (IVRA) and involves injecting local anesthetic into that limb. The method is frequently utilized in hand and forearm surgery. Local anesthetic is employed in the Bier block, which is administered into the venous system of an exsanguinated extremity. The local anesthetic solution is usually procaine at 0.25% to 0.5% or lidocaine at 0.5%.

Bier Block Procedure

A tourniquet is applied to a limb, typically the arm, to establish a bloodless field during the Bier block procedure. A local anesthetic, usually lidocaine, is then administered intravenously into the limb. The tourniquet limits the anesthetic's effects on the affected limb by stopping them from spreading throughout the body. As a result, less general anesthesia is required for surgical procedures and more regional anesthetic is possible. The tourniquet is taken off after the surgery, and the local anesthetic quickly leaves the bloodstream.

Bier Block Technique

A tourniquet is used to exsanguinate an upper or lower extremity, and then local anesthetic solutions are injected into the veins of that extremity. The Bier block facilitates active patient participation in the surgical procedure without inducing motor blockade, thereby permitting regular motion throughout the operation. It has a quick onset, and anesthetic effect is obtained within a few minutes of lidocaine injection. No motor blockade occurs, in contrast to brachial plexus blocks and other proximal regional anesthetic techniques. 

Bier Block Risks

Local anesthetic systemic toxicity (LAST) is the main concern; it happens seldom but can have serious consequences. Petechiae or skin discoloration, seizures, thrombophlebitis, nerve injury, and compartment syndrome are other problems. 

Surgical procedures longer than two hours, neuropathies, arrhythmias, an uncooperative patient, sickle cell disease, and Paget's disease are examples of relative contraindications. 

Bier Block Dose

The usual dosage for a Bier block, also called intravenous regional anesthesia (IVRA), is 0.6 mL/kg of 0.5% lidocaine or 3 mg/kg of lidocaine (lignocaine), up to a maximum of 200 mg or 40 mL. This approach is primarily utilized for brief procedures on the distal extremities (less than 60 minutes), such as hand surgeries, and it delivers total analgesia without the need for direct injection at the surgical site.