Have you discussed trying a brachial plexus block instead of Bier block? You don't need to be under anesthesia for a brachial plexus block, and they're not really painful to have (very quick).

I have had more than 10 stellate ganglion blocks. While those were helpful, once I switched PMs and he tried a series of brachial plexus blocks my pain decreased dramatically. I was able to go off of all of my long acting opiods and now just use short acting when needed.