RT Book, Section
A1 Reichman, Eric F.
SR Print(0)
ID 57713921
T1 Chapter 127. Intravenous Regional Anesthesia
T2 Emergency Medicine Procedures, 2e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-161352-1
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=57713921
RD 2024/04/23
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.