Intravenous regional anesthesia--first century (1908-2008). Beggining, development, and current status.

BACKGROUND AND OBJECTIVES: Intravenous regional block is celebrating its 10th anniversary in 2008. Since this is a widely used technique, this milestone should be recorded, the date celebrated, Brazilian anesthesiologists should be remembered of its evolutive process, especially in the last 40 years, and we should pay homage to the individual who started it: August Karl Gustav Bier.

CONTENTS: This report describes the beginning of locoregional anesthesia in general and regional intravenous block in particular, since the introduction of garroting of the extremities to the discovery and improvement of needles, syringes, and local anesthetics. The technical details used initially by Bier, and the pathophysiological and clinical concepts enounced by him at the beginning of the 20th Century are described. It describes the initial evolution and that of the following decades of intravenous regional block, lists national and international pioneers, explains the reasons for the relatively late scientific studies on the technique, and describes the main contributions that made it an effective and safe technique. Finally, it describes the current state of the main knowledge acquired over the years, such as the mechanism and site of action of the anesthetic and ischemia, the use of modern anesthetic solutions, improvement of postoperative analgesia and motor block, pharmacokinetic and pathophysiological concepts, and the best interpretation of possible complications.

CONCLUSIONS: Intravenous regional block is the anesthetic technique created by A. K. G Bier exactly 100 years ago. In the first half of the 20th Centuty, it evolved little and slowly, but in the last several years, it has seen an accentuated improvement, thanks to countless technical, pathophysiological, pharmacological, pharmacokinetic, and clinical developments, for which Brazilian Anesthesiology has contributed considerably. Since it is celebrating its 100th anniversary in 2008, intravenous regional block deserves to have its story told, and the date should not go unnoticed, but should be remembered and celebrated.