Safety and effectiveness of intravenous regional anesthesia (Bier block) for outpatient management of forearm trauma

CJEM. 2006 Jul;8(4):247-50. doi: 10.1017/s1481803500013786.


Objective: To assess the safety and effectiveness of intravenous regional anesthesia (Bier block) in the management of forearm injuries (i.e., forearm, wrist or hand) by primary care physicians at a diagnostic and treatment facility.

Methods: A retrospective review was conducted of all patients at a single centre who underwent a Bier block for forearm injuries between September 2000 and March 2005.

Results: 1816 Bier blocks were performed on 1804 patients (64% male) during the study period. Patient age ranged from 4-70 (mean 25) years. Wrist fractures requiring reduction were the most common diagnosis. Adverse events were recorded in 9 cases (0.50%, 95% confidence interval 0.23%-0.94%): 1 case of medication error (0.06%); 3 of improper cuff inflation (0.17%); and 5 of inadequate analgesia (0.28%). None of the adverse events resulted in failure to complete the procedure or in serious morbidity or mortality.

Conclusion: Bier block anesthesia is a safe, effective and reliable technique in an outpatient primary care setting. This technique is a useful modality for physicians who manage acute upper-extremity injuries.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care Facilities
  • Anesthetics, Local / therapeutic use
  • Arm Injuries / therapy*
  • Child
  • Child, Preschool
  • Female
  • Hand Injuries / therapy*
  • Humans
  • Lidocaine / therapeutic use
  • Male
  • Middle Aged
  • Nerve Block / adverse effects
  • Nerve Block / methods*
  • Primary Health Care
  • Retrospective Studies


  • Anesthetics, Local
  • Lidocaine