About Bier Block and Its Origins

A retired anesthesiologist with a career spanning three decades, Bobby Gene Bennett, Jr., MD, has served patients in numerous healthcare institutions across East Texas.

Fellowship trained in cardiac anesthesia, his practice also included general, pediatric, obstetric, transplant in addition to advanced interventional pain procedures such as epidurals, and common regional anesthesia, including femoral nerve blocks and Bier blocks.

The Bier block, also called intravenous regional anesthesia, was introduced by German surgeon August Bier. This anesthesia technique typically utilizes the combination of a double tourniquet, using a proximal cuff and distal cuff; and the injection of preservative-free prilocaine or lidocaine. It is suitable for short open surgical procedures or closed reductions involving the arm below the elbow or the leg below the knee. Typically, intravenous regional anesthesia is requested when the surgery is expected to be completed within 40 to 60 minutes.

Although August Bier introduced this block in 1908, it soon fell into disuse as anesthesia research advanced. However, it regained popularity in the 1960s. This technique is currently widely used because of its safety, cost-effectiveness, and simplicity, especially in minor surgeries such as hand ganglionectomy, Dupuytren contractures, carpal tunnel release, and reduction of fractures.