Intravenous regional blocks for acute pain management

An intravenous regional block (Bier block) provides anaesthesia to an upper limb and is commonly performed in emergency departments for fracture reduction (eg Colles fracture). It is an alternative to a peripheral nerve block for some surgical procedures.

Intravenous regional blocks must only be performed by practitioners experienced in their use.

To achieve blockade, prilocaine is administered intravenously to an upper limb, which has a double tourniquet applied to prevent rapid systemic absorption of the local anaesthetic. If systemic toxicity is suspected, ensure that the tourniquet is correctly applied to prevent further systemic absorption.

Vasoconstrictors (eg adrenaline [epinephrine]) are contraindicated in intravenous regional anaesthesia.