Intravenous regional anesthesia: Difference between revisions

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[[File:August Bier.jpg|thumb]] [[File:LimbProtectionSleeve.jpg|thumb]] Intravenous Regional Anesthesia
{{Short description|A technique for anesthesia of a limb}}


Intravenous regional anesthesia (IVRA), also known as Bier block, is a technique used to provide anesthesia to a limb, typically an arm or a leg, by injecting a local anesthetic into the venous system of the limb while it is isolated from the rest of the circulation by a tourniquet. This method is particularly useful for short surgical procedures on the extremities.
'''Intravenous regional anesthesia''' (IVRA), also known as '''Bier block''', is a technique used to anesthetize a limb for surgical procedures. It involves the administration of a local anesthetic into the venous system of the limb, which is isolated from the rest of the circulation by a tourniquet.


== History ==
==History==
The technique was first described by the German surgeon August Bier in 1908. Bier's initial method involved the use of procaine, a local anesthetic, and a tourniquet to isolate the limb. Over the years, the technique has evolved with the introduction of new local anesthetics and improvements in tourniquet technology.
[[File:August_Bier.jpg|thumb|left|August Bier, the pioneer of intravenous regional anesthesia]]
The technique was first described by the German surgeon [[August Bier]] in 1908. Bier's method involved the use of a tourniquet to occlude blood flow to the limb, followed by the injection of a local anesthetic into the venous system. This method provided effective anesthesia for limb surgeries and has been refined over the years.


== Indications ==
==Technique==
IVRA is primarily indicated for surgical procedures on the extremities that are expected to last less than 60 minutes. Common procedures include:
[[File:Venadaxili_regional_anesteziya.jpg|thumb|right|Diagram of intravenous regional anesthesia procedure]]
* Carpal tunnel release
The procedure begins with the application of a [[tourniquet]] to the limb to be anesthetized. The tourniquet is inflated to a pressure higher than the patient's systolic blood pressure to occlude arterial blood flow. Once the tourniquet is in place, a local anesthetic, such as [[lidocaine]], is injected into a vein in the limb.
* Ganglion cyst excision
* Dupuytren's contracture release
* Fracture reduction


== Contraindications ==
The anesthetic diffuses into the surrounding tissues, providing anesthesia to the entire limb. The tourniquet prevents the anesthetic from entering the systemic circulation, thus localizing its effects to the limb.
Contraindications for IVRA include:
* Severe peripheral vascular disease
* Sickle cell disease
* Infection at the site of injection
* Allergy to local anesthetics


== Technique ==
==Applications==
The procedure for IVRA involves several key steps:
IVRA is commonly used for procedures on the extremities, such as hand or foot surgeries. It is particularly useful for short procedures, as the duration of anesthesia is limited by the time the tourniquet can be safely applied.


=== Preparation ===
==Advantages and Disadvantages==
1. '''Patient Positioning''': The patient is positioned comfortably, usually supine, with the limb to be anesthetized elevated.
The primary advantage of IVRA is its simplicity and effectiveness for limb surgeries. It provides rapid onset of anesthesia and is relatively easy to administer. However, the duration of anesthesia is limited by the tourniquet time, and there is a risk of systemic toxicity if the tourniquet fails or is released prematurely.
2. '''Monitoring''': Standard monitoring includes ECG, blood pressure, and pulse oximetry.
3. '''Intravenous Access''': A cannula is inserted into a vein on the dorsum of the hand or foot of the limb to be anesthetized.


=== Tourniquet Application ===
==Safety Considerations==
1. '''Exsanguination''': The limb is elevated and exsanguinated using an Esmarch bandage to remove blood from the limb.
To minimize risks, careful monitoring of the patient is essential. The tourniquet should not be applied for more than 90 minutes to prevent ischemic damage to the limb. Additionally, the use of a limb protection sleeve can help prevent skin damage from the tourniquet.
2. '''Tourniquet Inflation''': A double-cuff tourniquet is applied to the proximal part of the limb and inflated to a pressure above the systolic blood pressure to occlude blood flow.


=== Anesthetic Injection ===
==Related pages==
1. '''Local Anesthetic''': A local anesthetic, such as lidocaine, is injected into the venous system of the isolated limb.
* [[Local anesthesia]]
2. '''Onset of Anesthesia''': Anesthesia typically occurs within 5-10 minutes.
 
=== Maintenance and Monitoring ===
1. '''Tourniquet Management''': The tourniquet is maintained throughout the procedure to prevent systemic absorption of the anesthetic.
2. '''Monitoring''': The patient is continuously monitored for signs of tourniquet pain or systemic toxicity.
 
=== Completion ===
1. '''Tourniquet Deflation''': At the end of the procedure, the tourniquet is deflated slowly to allow gradual systemic absorption of the anesthetic.
2. '''Recovery''': The patient is observed for any adverse effects as the anesthetic wears off.
 
== Complications ==
Potential complications of IVRA include:
* '''Tourniquet Pain''': Discomfort due to prolonged tourniquet inflation.
* '''Local Anesthetic Toxicity''': Systemic absorption of the anesthetic can lead to toxicity, manifesting as CNS or cardiovascular symptoms.
* '''Nerve Injury''': Rarely, nerve injury can occur due to prolonged tourniquet application.
 
== Advantages and Disadvantages ==
 
=== Advantages ===
* Simple and rapid onset of anesthesia.
* Minimal systemic effects if performed correctly.
* Cost-effective for short procedures.
 
=== Disadvantages ===
* Limited to procedures of short duration.
* Risk of local anesthetic toxicity.
* Tourniquet pain can limit the duration of anesthesia.
 
== Also see ==
* [[Regional anesthesia]]
* [[Regional anesthesia]]
* [[Local anesthetic]]
* [[Tourniquet]]
* [[Tourniquet]]
* [[Peripheral nerve block]]
{{Anesthesia}}


[[Category:Anesthesia]]
[[Category:Anesthesia]]
[[Category:Medical procedures]]

Latest revision as of 20:57, 21 February 2025

A technique for anesthesia of a limb


Intravenous regional anesthesia (IVRA), also known as Bier block, is a technique used to anesthetize a limb for surgical procedures. It involves the administration of a local anesthetic into the venous system of the limb, which is isolated from the rest of the circulation by a tourniquet.

History[edit]

August Bier, the pioneer of intravenous regional anesthesia

The technique was first described by the German surgeon August Bier in 1908. Bier's method involved the use of a tourniquet to occlude blood flow to the limb, followed by the injection of a local anesthetic into the venous system. This method provided effective anesthesia for limb surgeries and has been refined over the years.

Technique[edit]

Diagram of intravenous regional anesthesia procedure

The procedure begins with the application of a tourniquet to the limb to be anesthetized. The tourniquet is inflated to a pressure higher than the patient's systolic blood pressure to occlude arterial blood flow. Once the tourniquet is in place, a local anesthetic, such as lidocaine, is injected into a vein in the limb.

The anesthetic diffuses into the surrounding tissues, providing anesthesia to the entire limb. The tourniquet prevents the anesthetic from entering the systemic circulation, thus localizing its effects to the limb.

Applications[edit]

IVRA is commonly used for procedures on the extremities, such as hand or foot surgeries. It is particularly useful for short procedures, as the duration of anesthesia is limited by the time the tourniquet can be safely applied.

Advantages and Disadvantages[edit]

The primary advantage of IVRA is its simplicity and effectiveness for limb surgeries. It provides rapid onset of anesthesia and is relatively easy to administer. However, the duration of anesthesia is limited by the tourniquet time, and there is a risk of systemic toxicity if the tourniquet fails or is released prematurely.

Safety Considerations[edit]

To minimize risks, careful monitoring of the patient is essential. The tourniquet should not be applied for more than 90 minutes to prevent ischemic damage to the limb. Additionally, the use of a limb protection sleeve can help prevent skin damage from the tourniquet.

Related pages[edit]