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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 9 – Intravenous Regional Block


Intravenous (IV) regional anesthesia was introduced by Bier in 1908. As illustrated in Figure 9-1 , the initial description noted that a surgical procedure was required to cannulate a vein, and both proximal and distal tourniquets were used to contain the local anesthetic in the venous system. After its introduction, the technique fell into disuse until the less toxic amino amides became available during the mid-twentieth century. This technique can be used for a variety of upper extremity operations, including soft tissue and orthopedic procedures, primarily in the hand and forearm. The technique has also been used for foot procedures with a calf tourniquet.

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Figure 9-1  Early Bier block: surgical technique.

Patient Selection.

The technique is best suited for patients in whom there is no disruption of the venous system of the involved upper extremity because the technique relies on an intact venous system. It can be used for distal orthopedic fractures and soft tissue operations. IV regional block may not be appropriate for patients in whom movement of the upper extremity causes significant pain because movement of the upper extremity is required for adequate exsanguination of blood from the venous system.

Pharmacologic Choice.

The most commonly used agent for IV regional anesthesia is a dilute concentration of lidocaine, although prilocaine has also been used successfully. Lidocaine is used in a 0.5% concentration; and approximately 50 mL is needed for an upper extremity IV regional block.

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