Bier's Block (Intravenous Regional Anesthesia)
Bier's Block (Intravenous Regional Anesthesia)
(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.