A Bier block 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.