Kenneth D. Candido, Anthony R. Tharian, and Alon P. Winnie INTRODUCTION The technique of intravenous regional anesthesia (IVRA), or “Bier block,” was first introduced in 1908 by the German surgeon August Bier. A Bier block essentially consists of injecting local anesthetic solutions into the venous system of an upper or lower extremity that has been exsanguinated by compression or gravity …