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In searching for a method to avoid the difficulties of nerve-blocking anesthesia, Bier1 developed the idea of Venenanästhesie which he reported at the thirty-seventh German Surgical Congress, in 1908. In 1909, he reported a series of 134 cases and gave in detail the technic of the method.2
The anesthetizing solution is injected into the veins, in a bloodless segment between two Esmarch bandages. The tissues in this segment become anesthetized almost at once. This is called the "direct anesthesia." After a short time the limb distal to the segment becomes anesthetized followed by motor paralysis. This is the "indirect anesthesia." The injected solution reaches the smallest vessels in all tissue, even to the bone-marrow. The veins swell as the injection proceeds, but the swelling soon disappears due to the rapid diffusion of the anesthetizing solution throughout the tissues. The whole thickness of the limb becomes anesthetic. The direct
SMITH C. INTRAVENOUS LOCAL ANESTHESIA. JAMA. 1912;LVIII(12):855–856. doi:10.1001/jama.1912.04260030253013
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