Related Experiment Video
Updated: Jan 6, 2026
03:14
Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
1.2K
Intravenous Regional Anesthesia: A Historical Overview and Clinical Review.
Benjamin Löser1, Martin Petzoldt2, Anastassia Löser3
1Center of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, University Medicine Rostock, Schillingallee 35, 18057 Rostock, Germany.
Journal of Anesthesia History
|October 2, 2019
Summary
Intravenous regional anesthesia (IVRA), or Bier's Block, is a safe and effective limb anesthesia technique. Modern advancements enhance its safety and utility for various surgical procedures and pain management.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Intravenous regional anesthesia (IVRA), also known as Bier's Block, has a history dating back to 1908.
- Its popularity waned with the rise of neuroaxial techniques but resurged in the 1960s due to improved local anesthetics.
Observation:
- IVRA is widely used globally in emergency settings, for outpatients, and high-risk patients.
- It provides a favorable risk-benefit profile, cost-effectiveness, muscle relaxation, and rapid onset/offset.
- Recent advancements in monitoring and equipment have further improved IVRA safety.
Findings:
- Prilocaine and lidocaine are preferred local anesthetics for IVRA.
- Adjuvants are used to enhance IVRA effects and mitigate tourniquet pain.
- Major adverse events are rare, though systemic toxicity must be prevented.
Implications:
- IVRA remains a valuable anesthetic option, particularly for limb surgeries.
- It can be applied in managing complex regional pain syndromes.
- This review offers a historical perspective and current clinical insights into IVRA.
Related Concept Videos
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
1.1K
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
1.1K
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
658
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
658
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
1.2K
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
1.2K
01:24Parenteral Anesthetics: Overview
540
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
540
01:30Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
1.8K
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
1.8K
01:24General Anesthesia: Overview
533
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
533