MGH Orthopaedic Ambulatory Surgery Center Anesthesia Bier Block

BIER BLOCK/IV REGIONAL

The Bier block or IV regional is a regional anesthetic technique used for surgery of the elbow, forearm, wrist and hand. It is a safe and effective block that provides both safe and excellent surgical anesthesia. Unlike the other regional techniques the Bier block or IV regional is a short lasting regional technique and is performed in the operating room itself.

On arrival to the prep area at the ASC the risks and benefits of the procedure will be discussed with you before you sign your consent. An IV catheter will be place on the back of the hand to be operated on. Once the surgeon, operating room (OR) and OR team are ready, you will then proceed to the operating room.

You will then be attached to the usual monitors: a blood pressure cuff, a light sensor to measure your blood oxygen level will be attached to your finger, and EKG leads will be placed on your chest. You will receive some sedation through your intravenous prior to placement of the block, which both relax you and will likely cause you to have little or no recollection of the block placement.

Next, the anesthetist will position you for the block. He or she will ask you to remain lying on your back. The anesthesiologist will then place a deflated tourniquet around your upper arm or forearm. An assistant will hold the hand of the operative above you. The anesthetist will then wrap from your hand to the tourniquet with a large rubber band to force the blood out. Then the tourniquet will be inflated. This prevents blood from coming back into the arm and prevents local anesthetic from leaving the arm during the surgery. Once it is confirmed that the tourniquet is functioning properly Lidocaine local anesthetic will be injected into the IV on the back of the hand. After the injection of local anesthetic, the IV catheter will be removed.

The block takes about 5 to 10 minutes to work. As the block begins to work you may experience a short-lived burning or warm sensation in your arm and hand, then your arm, wrist and hand will become numb. You will receive additional intravenous sedation once the block is in which will make you more relaxed and you will likely have no recall of the surgery. The surgeon may place additional local anesthetic in the incision to help with post-operative pain.

Upon finishing the surgery, the tourniquet is deflated and the blood returns to your arm and hand washing out the lidocaine local anesthesia. Normal feelings and movement will return very shortly thereafter.

After the surgery and transport to the recovery room. The block will have worn off. Shortly the sedation will begin to wear off. You will receive pain medicine in the recovery room, if you need it.