Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications

Study Objective: To characterize the complications reported with intravenous regional anesthesia (IVRA). Design: Literature search. Setting: University-affiliated hospital. Measurements: A search was done in the American National Library of Medicine's PUBMED, EMBASE (1980-2007, wk 11), and Medline (from 1950) in March 2007. All complications associated with IVRA were reviewed. Main Results: The lowest dose of local anesthetic associated with a seizure was 1.4 mg/kg for lidocaine; 4 mg/kg for prilocaine, and 1.3 mg/kg for bupivacaine. Cardiac arrests and deaths were reported with lidocaine and bupivacaine only. The lowest dose associated with a cardiac arrest was 2.5 mg/kg for lidocaine and 1.6 mg/kg for bupivacaine. Local anesthetic toxicity occurring during tourniquet inflation has been reported, with tourniquet pressure exceeding initial systolic arterial blood pressure by 150 mmHg. Seizures occurring after tourniquet deflation have been reported with a tourniquet time as long as 60 minutes. Ten cases of compartment syndrome are reported. Conclusion: Seizures have been reported with lidocaine at its lowest effective dose (1.5 mg/kg). (C) 2009 Elsevier Inc. All rights reserved.