Intravenous regional anesthesia

Perform intravenous regional anesthesia

The intravenous regional anesthesia (IVRA) or beer-block after August Bier is a method of regional anesthesia allows the surgery to arm or leg. The extremity to be operated on is drained of blood and tied. The veins are then filled with local anesthetic, which diffuses from there into sensitive nerve endings and nerve tracts and blocks the transmission of pain in these.

Indications, contraindications

For operations on the forearm, hand, lower leg or foot, which can be carried out within about an hour, the IVRA is a safe anesthetic procedure that is relatively easy to perform, good pain elimination and a quick onset of action. Due to the short duration of action, it is often used on outpatients Interventions used. Disadvantages are the limitation of the possible duration of the procedure, the painfulness of setting, a possible risk of toxic symptoms if the procedure is not carried out correctly, and the lack of a lasting pain-relieving effect after the procedure has ended.

Contraindications are local infections, vascular and heart diseases, peripheral neuropathies , Raynaud's syndrome and sickle cell anemia .

execution

After an indwelling venous cannula has been placed , the affected extremity is emptied of blood by holding it up and unrolling it; the extremity is tied off from the blood supply by inflating a pressure cuff. Local anesthetic is slowly injected into the emptied veins . Mostly prilocaine is used, which is characterized by low toxicity . It takes 5–10 minutes to take effect and the procedure can be carried out. The cuff must not be opened until after 30 minutes at the earliest.

Side effects

When used correctly, intravenous regional anesthesia is a safe procedure with an extremely low rate of complications (0.01%). A common but harmless side effect is tourniquet pain from the binding cuff. This side effect can be prevented by using a double cuff in which only the proximal cuff is inflated before the veins are filled with local anesthetic , and then the distal cuff is inflated after the anesthesia has started. If only the distal cuff remains inflated, the tourniquet pain does not apply, if both cuffs remain inflated, there is a safeguard against the systemic toxicity of the local anesthetic, because the local anesthetic can be potentially serious, even if rarely, if it enters the circulation systemic toxicity can cause paresthesia in the mouth, tinnitus , seizures , unconsciousness , cardiac arrhythmias , respiratory depression and possibly cardiac arrest . This can occur from cuff leakage or premature deflation, but has also been observed when used correctly.

swell

• Rolf Rossaint, Christian Werner, Bernhard Zwissler (ed.): The anesthesiology. General and special anesthesiology, pain therapy and intensive care medicine. 2nd Edition. Springer, Berlin 2008, ISBN 978-3-540-76301-7 , pp. 683-685.
• Danilo Jankovic: Regional blockades and infiltration therapy. 3. Edition. Abw Wissenschaftsverlag, 2003, ISBN 3-936072-16-7 , pp. 159-163.

Individual evidence

1. ↑ A. Bier: About a new way of producing local anesthesia on the limbs. In: Arch. Klin. Chir. 86, 1908, pp. 1007-1016.
2. ^ K. Bartholomew, JP Sloan: Prilocaine for Bier's block: how safe is safe? In: Arch Emerg Med. 7 (3), Sep 1990, pp. 189-195. PMID 2152460

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