Intravenous regional anesthesia

Intravenous regional anesthesia ( IVRA ) or Bier- block after August Beer is a method of regional anesthesia, which allows surgical procedures on the arm or leg. The limb to be operated on is deflated and tied by blood. The veins are then filled with local anesthetic diffuses from there to sensitive nerve endings and nerve tracts and blocks in this pain transmission.

Indications, contraindications

In operations on the forearm, hand, lower leg or foot, which can be carried out in the period of about an hour, is the IVRA a safe anesthetic procedures with relatively simple feasibility, good pain control and fast onset of action dar. Due to the short duration of action, it is often in ambulatory interventions used. A disadvantage is the limitation of the possible duration of engagement, the pain of setting, a possible risk of toxic symptoms in case of improper conduct and the absence are a persistent pain effect after the trial.

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

Implementation

Following the placement of an IV catheter, the affected limb is exsanguinated by holding up and unwrapping, by inflating a pressure cuff, the limb is tied off from the blood supply. In the emptied veins local anesthetic is injected slowly. In most cases here prilocaine is used, which is characterized by low toxicity. After 5-10 minutes, the effect is occurred, the engagement can be performed. The cuff must be opened at the earliest after 30 minutes.

Side effects

When properly applied, intravenous regional anesthesia is a safe procedure with a very low complication rate (0.01%). A common but harmless side effect of tourniquet pain by the cuff -setting. Potentially serious, although rare is a transgression of local anesthetic into the circulation, where it may cause as a result of systemic toxicity paresthesia around the mouth, tinnitus, seizures, loss of consciousness, cardiac arrhythmias, respiratory depression, and maybe a cardiac arrest. This can be caused by leaks in the cuff or early draining, but has been observed when used correctly.

Swell

• Rossaint, Werner, Zwissler (ed. ): The anesthesiology. General and special Anesthesiology, Pain Management and Intensive Care Medicine, pp. 683-5. Springer, Berlin; 2nd edition, 2008. ISBN 978-3540763017
• Jankovic: Regional blocks and infiltration therapy, p.159 - 163rd Dev scientific publishing; 3rd edition, 2003. ISBN 3-93-6072167