Intravenous regional anesthesia: Difference between revisions

Revision as of 04:25, 29 December 2024

A method of anesthesia involving intravenous injection

Pronunciation
Other names
Specialty
Uses
Complications
Approach
Types
Recovery time
Other options
Frequency

Intravenous regional anesthesia (IVRA), also known as Bier block, is a method of anesthesia that involves the intravenous injection of a local anesthetic into a limb that has been isolated from the rest of the circulation by a tourniquet. This technique is primarily used for short surgical procedures on the extremities.

History

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 of the isolated limb.

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 ensure complete occlusion of blood flow. A local anesthetic, such as lidocaine, is then injected into a vein in the isolated limb. The anesthetic diffuses into the surrounding tissues, providing anesthesia to the entire limb.

Indications

IVRA is indicated for short surgical procedures on the extremities, such as carpal tunnel release, ganglion cyst excision, and fracture reduction. It is particularly useful for procedures that are expected to last less than 60 minutes.

Advantages

Rapid onset of anesthesia
Minimal systemic absorption of the anesthetic
Easy to administer

Disadvantages

Risk of tourniquet pain if the procedure is prolonged
Potential for local anesthetic toxicity if the tourniquet fails
Limited to procedures on the extremities

Complications

Complications of IVRA can include tourniquet pain, local anesthetic toxicity, and nerve injury. Proper technique and monitoring are essential to minimize these risks.

References

External links

Wikimd: Intravenous Regional Anesthesia

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-[[File:August Bier.jpg|thumb]] [[File:LimbProtectionSleeve.jpg|thumb]] Intravenous Regional Anesthesia
-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.
+{{Short description|A method of anesthesia involving intravenous injection}}
+{{Infobox medical procedure
+| name         = Intravenous Regional Anesthesia
+| image        = <!-- Image removed -->
+| caption      =
+| ICD10        =
+| ICD9         =
+| MeshID       = D000777
+| MedlinePlus  =
+| eMedicine    =
+}}
-== History ==
+'''Intravenous regional anesthesia''' (IVRA), also known as '''Bier block''', is a method of [[anesthesia]] that involves the intravenous injection of a local anesthetic into a limb that has been isolated from the rest of the circulation by a [[tourniquet]]. This technique is primarily used for short surgical procedures on the extremities.
-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.
-== Indications ==
+==History==
-IVRA is primarily indicated for surgical procedures on the extremities that are expected to last less than 60 minutes. Common procedures include:
+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 of the isolated limb.
-* Carpal tunnel release
-* Ganglion cyst excision
-* Dupuytren's contracture release
-* Fracture reduction
-== Contraindications ==
+==Procedure==
-Contraindications for IVRA include:
+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 ensure complete occlusion of blood flow. A local anesthetic, such as [[lidocaine]], is then injected into a vein in the isolated limb. The anesthetic diffuses into the surrounding tissues, providing anesthesia to the entire limb.
-* Severe peripheral vascular disease
-* Sickle cell disease
-* Infection at the site of injection
-* Allergy to local anesthetics
-== Technique ==
+==Indications==
-The procedure for IVRA involves several key steps:
+IVRA is indicated for short surgical procedures on the extremities, such as [[carpal tunnel release]], [[ganglion cyst]] excision, and [[fracture]] reduction. It is particularly useful for procedures that are expected to last less than 60 minutes.
-=== Preparation ===
+==Advantages==
-. '''Patient Positioning''': The patient is positioned comfortably, usually supine, with the limb to be anesthetized elevated.
+* Rapid onset of anesthesia
-. '''Monitoring''': Standard monitoring includes ECG, blood pressure, and pulse oximetry.
+* Minimal systemic absorption of the anesthetic
-. '''Intravenous Access''': A cannula is inserted into a vein on the dorsum of the hand or foot of the limb to be anesthetized.
+* Easy to administer
-=== Tourniquet Application ===
+==Disadvantages==
-. '''Exsanguination''': The limb is elevated and exsanguinated using an Esmarch bandage to remove blood from the limb.
+* Risk of [[tourniquet pain]] if the procedure is prolonged
-. '''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.
+* Potential for local anesthetic [[toxicity]] if the tourniquet fails
+* Limited to procedures on the extremities
-=== Anesthetic Injection ===
+==Complications==
-. '''Local Anesthetic''': A local anesthetic, such as lidocaine, is injected into the venous system of the isolated limb.
+Complications of IVRA can include [[tourniquet pain]], local anesthetic toxicity, and [[nerve injury]]. Proper technique and monitoring are essential to minimize these risks.
-. '''Onset of Anesthesia''': Anesthesia typically occurs within 5-10 minutes.
-=== Maintenance and Monitoring ===
+==See also==
-. '''Tourniquet Management''': The tourniquet is maintained throughout the procedure to prevent systemic absorption of the anesthetic.
-. '''Monitoring''': The patient is continuously monitored for signs of tourniquet pain or systemic toxicity.
-=== Completion ===
-. '''Tourniquet Deflation''': At the end of the procedure, the tourniquet is deflated slowly to allow gradual systemic absorption of the anesthetic.
-. '''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]]
 * [[Local anesthetic]]
-* [[Tourniquet]]
 * [[Peripheral nerve block]]
-{{Anesthesia}}
+==References==
+{{Reflist}}
+==External links==
+* [https://www.wikimd.com/wiki/Intravenous_regional_anesthesia Wikimd: Intravenous Regional Anesthesia]
 [[Category:Anesthesia]]
 [[Category:Medical procedures]]
+[[Category:Regional anesthesia]]