The Bier Block or IV Regional is a regional anesthetic technique used for surgery of the forearm, wrist and hand. It is an effective block that provides both safe and excellent surgical anesthesia for short and less painful surgeries. 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 a description of the regional procedure as well as the risks and benefits of the procedure will be discussed. Any questions you may have will be answered at that time 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 be transferred 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 will 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. A deflated tourniquet will then be place around the operative side upper arm or forearm. An assistant will hold the hand of the operative side above you. A large rubber band will be wrapped from your hand to the tourniquet forcing the blood out of your arm. Then the tourniquet will be inflated. This prevents blood from coming back into the arm and also prevents local anesthetic from leaving the arm during the surgery. Once it is confirmed that the tourniquet is functioning properly Lidocaine, the 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 completion of the surgery, the tourniquet is deflated and the blood flow returns to your arm and hand washing out the lidocaine local anesthesia. Normal feelings and movement will return very shortly thereafter.
After the surgery you will be transported to the recovery room. The block will have worn off. Shortly the sedation will begin to wear off. You will receive supplemental post-op pain medicine in the recovery room, if you need it.