An update on Intravenous Regional Anaesthesia of the arm.

Intravenous Regional Anaesthesia (IVRA) has been first described in 1908 by the german surgeon August KG Bier. Although the technique was easy to perform and effective in giving surgical anaesthesia, the newer plexus block techniques largely replaced in a short time the "Bier block", because of time limitations of IVRA and safety considerations. Throughout the years modifications in procedure and new pharmacologic adjuvants have been shown to prevent toxic reactions to anaesthetics and mitigate limitations of IVRA. This paper rewiews the technique itself, its historical background, procedural modifications to improve its safety and efficiency, pharmacologic adjuvants acting on onset time of anaesthesia and on tourniquet pain, and drugs improving postoperative analgesia and muscle relaxation. The economic side of IVRA is also discussed.