IVRA is contraindicated in -

Intravenous regional anaesthesia (IRVA) was first described by Augustus Bier in 1908; his technique was repopularised by Holmes in 1963. The administration of intravenous local anaesthetic in an isolated limb by means of an ischaemic cuff is a simple and effective technique, with a low incidence of failure and high degree of safety Contraindications to IVRA Severe Raynaud's Disease (intermittent aeriolar vasospasm of the distal limbs after cold or emotional stimuli). Sickle Cell Disease (IVRA is relatively contraindicated, unless meticulous exsanguination of the limb takes place prior to cuff inflation). Crush injury to the limb, IVRA may provoke fuher tissue damage secondary to hypoxia. Age - young children are generally not amenable to IVRA alone, however in combination with sedation and additional analgesia it can be used successfully. Patients should be starved, as there may be a possibility of conversion to a general anaesthetic, alternatively the patient may require sedation in addition to IVRA to improve co-operation. Ref -pubmed.com , journal on Bier's block