Bier Block

What is a Bier Block?

A Bier block essentially consists of injecting local anesthetic solutions into the venous system of an upper or lower extremity that has been stopped of blood flow by compression or gravity and that has been isolated by means of a tourniquet from the central circulation.

bier block

The Procedure

Bier blocks can be performed on extremities. An intravenous line is started in the extremity. The extremity is then wrapped in a rubber/elastic bandage called Esmarch, this can be painful for the patient in some cases. Once the bandage is placed a tourniquet is used to stop blood flow from going into the extremity.

As soon as the tourniquet is in place the Esmarch is removed. Local anesthetic or a mixture of anesthetic and other pain medications such as Toradol and ketamine are injected into the intravenous line that is in place. The tourniquet can be in place for up to an hour. Once the provider feels that a sufficient time has passed, the tourniquet will be slowly released.

The Risks

Risks include potential for nerve damage, compartment syndrome, skin discoloration or petechiae, and thrombophlebitis. The most common adverse event encountered during a Bier block is tourniquet pain.  The Bier block is a safe, effective, and cost-effective way to provide anesthesia and analgesia for extremities. This elegant technique requires minimal additional equipment and can be performed in a variety of clinical environments.