Introduction: Intravenous regional anesthesia (IVRA, Bier's Block) is an effective method of providing anesthesia for extremity surgery with published success rates ranging from 94%-100%. It is safe and effective when performed carefully. The technique is most suitable for short-duration, less than 60 minutes surgical procedures in distal extremities (forearm, hand, ankle and foot). Earlier studies recommended that IVRA be performed by anesthesiologists who are familiar with the technique and fully trained to treat its complications.

Objective: The purpose of this study is to demonstrate that IVRA administered by the operating plastic surgeon during surgery involving mainly the upper extremity, without anesthetic team involvement, is safe, has minimal complications, is simple to perform and is an efficient technique in a surgical ambulatory setting.

Methods: A 5 year retrospective chart review (January 2000-December 2004) was undertaken at Maisonneuve Rosemont Hospital - Ambulatory Surgical Center. The study included patients who underwent surgical procedures and were administered IVRA by the surgeon.

Results: 448 patients were included in the study and 483 surgeries were performed. IVRA was efficient in 99.8 % (478/479) of the cases. 5 cases (5/483,1%) of tourniquet related technical problems were noted, resulting in cancellation of 4 surgeries with no reported consequent anesthetic toxicity. Minor complications (metallic taste, tinnitus, dizziness, asymptomatic bradycardia, chest pain) were reported in 1.3% (6/479) of the cases. No major cardiovascular or neurological complications did occur.

Conclusion: As outpatient surgery continues to grow, there is an increasing interest in the use of regional techniques to provide anesthesia for surgeries of the upper extremity . Despite earlier worries about the safety of IVRA if not administered by anesthesiologists familiar with the technique, we found that IVRA represents a safe and efficient technique of anesthesia for extremity surgery when performed appropriately by the operating surgeon. We recommend that plastic surgeons familiarize themselves with this technique which is simple, safe, and efficient. This could probably result at the end in lower overall cost and a greater autonomy for the surgeon.
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