The Bier block, or intravenous regional anaesthesia (IVRA), is a safe, cost-effective technique providing anaesthesia and analgesia for short-duration limb surgeries. It is primarily used for distal upper and lower extremity procedures lasting up to 60 minutes, such as fracture reductions, soft tissue surgeries, and carpal tunnel release. The technique involves exsanguination of the limb using an elastic bandage followed by inflation of a double-cuff tourniquet to maintain a bloodless field. Local anaesthetic (e.g., lidocaine or prilocaine) is then injected intravenously into the isolated limb. When performed correctly, the Bier block offers high success rates (96–100%) with minimal systemic effects. Tourniquet pain is a limiting factor, usually requiring cuff cycling for procedures exceeding 30 minutes. Safe deflation using a three-cycle inflation-deflation technique minimises the risk of local anaesthetic systemic toxicity (LAST). While generally safe, complications can include inadequate anaesthesia due to poor exsanguination, tourniquet failure, nerve injury, and methemoglobinemia with prilocaine use. Careful patient selection is essential, as contraindications include crush injuries, severe vascular disease, and uncooperative patients. The Bier block remains a valuable tool for outpatient and emergency settings, offering rapid onset, reliable anaesthesia, and reduced opioid requirements.