Intravenous regional anesthesia (IVRA) is established by administration of local anesthetics in a vein on the extremity, isolated from the rest of the body by a pneumatic tourniquet. The local anesthetics act directly on the small nerve endings and on bigger nerves in the cubital fossa. After thirty minutes ischemia contributes to analgesia. Exsanguination before the application of the tourniquet is most efficiently achieved by Esmarch bandage. By using a two-chamber pneumatic tourniquet the onset of pain from the tourniquet can be delayed. Prilocaine, mepivacaine and lidocaine are all short-lasting local analgesics that have been used for intravenous regional anesthesia. The analgesia wears off within minutes after deflation of the tourniquet. When NSAIDs are administered together with the local anesthetics in the intravenous regional anesthesia it is possible to achieve a prolonged postoperative analgesia. Bier's block from 1908 is still today reliable, fast and low-cost anesthesia with very few significant side effects. The most important disadvantage is the tourniquet pain that limits the operating time.