<br />Bier’s Block is a regional anesthesia technique used for procedures on the upper and lower limbs. It was first introduced by August Bier in 1908 and remains a simple and effective method for short surgical interventions, especially in orthopedic and hand surgery.<br /><br />Technique<br /> 1. Preparation: A tourniquet is applied proximally on the limb to restrict blood flow.<br /> 2. Exsanguination: The limb is elevated and wrapped with an elastic bandage (e.g., Esmarch bandage) to remove venous blood.<br /> 3. Tourniquet Inflation: The tourniquet is inflated to a pressure higher than the patient’s systolic blood pressure to prevent local anesthetic from entering systemic circulation.<br /> 4. Injection of Local Anesthetic:<br /> • Lidocaine 0.5% (3 mg/kg) is commonly used (without epinephrine).<br /> • Prilocaine 0.5% can also be used due to its lower toxicity risk.<br /> 5. Surgical Procedure: The limb remains anesthetized for the duration of the tourniquet application.<br /> 6. Tourniquet Release: To avoid systemic toxicity, the tourniquet is deflated gradually after a minimum of 20-30 minutes.<br /><br />Indications<br /> • Hand, wrist, and forearm surgeries<br /> • Minor orthopedic procedures (e.g., tendon repairs, fracture reductions)<br /> • Soft tissue debridement<br /><br />Contraindications<br /> • Severe peripheral vascular disease<br /> • Sickle cell disease<br /> • Allergy to local anesthetics<br /> • Infection at the site<br /><br />Advantages<br /> • Provides effective analgesia with minimal systemic drug absorption<br /> • Rapid onset and recovery<br /> • Avoids the need for general anesthesia<br /><br />Disadvantages<br /> • Risk of local anesthetic systemic toxicity (LAST) if the tourniquet fails<br /> • Tourniquet pain if prolonged beyond 45–60 minutes<br />By <br />B.M.TECH<br />OSAMAH AZIZ <br />References<br /> 1. Bier, A. (1908). “A New Method for Local Anesthesia in the Extremities.” Annals of Surgery, 48(1), 1–7.<br /> 2. Brown, D. L., & Miller, R. D. (2010). Miller’s Anesthesia (7th ed.). Elsevier.<br /> 3. Guay, J. (2009). “Adverse Events Associated with Intravenous Regional Anesthesia (Bier Block).” Anesthesia & Analgesia, 109(2), 543–551.<br />Al-Mustaqbal University is the first university in Iraq