TY  - CHAP
M1  - Book, Section
TI  - Intravenous Regional Block for Upper and Lower Extremity Surgery
A1  - Candido, Kenneth D.
A1  - Tharian, Anthony R.
A1  - Winnie, Alon P.
A2  - Hadzic, Admir
PY  - 2017
T2  - Hadzic's Textbook of Regional Anesthesia and Acute Pain Management, 2e
AB  - The  technique  of  intravenous  regional  anesthesia  (IVRA),  or  “Bier  block,”  was  first  introduced  in  1908  by  the  German  surgeon  August  Bier.1  A  Bier  block  essentially  consists  of  injecting  local  anesthetic  solutions  into  the  venous  system  of  an  upper  or  lower  extremity  that  has  been  exsanguinated  by  compression  or  gravity  and  that  has  been  isolated  by  means  of  a  tourniquet  from  the  central  circulation.  In  Bier’s  original  technique,  the  local  anesthetic  procaine  in  concentrations  of  0.25%  to  0.5%  was  injected  through  an  intravenous  cannula,  which  had  been  placed  between  two  Esmarch  bandages  utilized  as  tourniquets  to  divide  the  arm  into  proximal  and  distal  components.2,3,4after  injecting  the  local  anesthetic,  Bier  noted  two  distinct  types  of  anesthesia:  an  almost-immediate  onset  of  “direct”  anesthesia  between  the  two  tourniquets  and  then,  after  a  delay  of  5  to  7  minutes,  an  “indirect”  anesthesia  distal  to  the  distally  placed  tourniquet.  By  performing  dissections  of  the  venous  system  of  the  upper  extremity  in  cadavers  after  injecting  methylene  blue,  Bier  was  able  to  determine  that  the  direct  anesthesia  was  the  result  of  local  anesthesia  bathing  bare  nerve  endings  in  the  tissues,  whereas  the  indirect  anesthesia  was  most  probably  due  to  local  anesthesia  being  transported  to  the  substance  of  the  nerves  via  the  vasa  nervorum,  where  a  typical  conduction  block  occurs.  Bier’s  conclusion  was  that  two  mechanisms  of  anesthesia  were  associated  with  this  technique:  peripheral  infiltration  block  and  conduction  block.  The  technique,  as  originally  described  by  Bier,  remains  essentially  unchanged  in  modern  practice  for  the  past  106  years,  except  for  the  introduction  of  the  pneumatic-type  double-tourniquet  preparation  used  in  current  clinical  practice5,6,7  (Figure  21–1).  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1141732237
ER  -