TY - CHAP M1 - Book, Section TI - Chapter 127. Intravenous Regional Anesthesia A1 - Reichman, Eric F. PY - 2013 T2 - Emergency Medicine Procedures, 2e AB - The technique of intravenous regional anesthesia (IVRA) was first introduced by August Bier in 1908.1 IVRA essentially consists of injecting local anesthetic solution into the venous system of an extremity (upper or lower) that has been exsanguinated by compression and/or gravity and isolated from the central circulation by means of a tourniquet. Procaine in concentrations of 0.25% to 0.5% was injected through an intravenous cannula placed between two Esmarch bandages utilized as tourniquets to divide the arm into proximal and distal compartments in Bier's original technique.2–4 He noted two distinct types of anesthesia. The first was an almost immediate onset of “direct” anesthesia between the two tourniquets. An “indirect” anesthesia distal to the distally placed tourniquet was noted after a delay of 5 to 7 minutes. This technique was eventually renamed the Bier block. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/10/07 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=57713921 ER -