Intravenous regional anaesthesia

Intravenous regional anaesthesia of the arm. Effect of the technique of exsanguination on the quality of anaesthesia and prilocaine plasma concentrations

The effects of different techniques of exsanguination of the upper arm during intravenous regional anaesthesia on prilocaine plasma concentrations, quality of anaesthesia, toxic symptoms after deflation of the tourniquet and injection pressure of the anaesthetic were studied in 10 healthy male volunteers. The nondominant arm was exsanguinated using either Esmarch's bandage or elevation of the arm for 2 minutes plus arterial occlusion by compression of the brachial artery. The injection pressure after the prilocaine dose (3 mg/kg) was significantly higher in the elevation group (maximally 98 mmHg). There were no statistically significant differences in the onset of, or recovery from, anaesthesia between the groups. Various mild toxic symptoms were experienced in the central nervous system after deflation of the tourniquet. However, there was no correlation between the two techniques and the degree of severity of the toxic symptoms. The highest single venous plasma concentration (total) of prilocaine was 2.3 micrograms/ml measured from the contralateral cubital vein (elevation group, 2 minutes). The differences in prilocaine concentrations between the groups were not statistically significant.

Intravenous regional anesthesia

Intravenous regional anesthesia is a simple and effective method of analgesia of an extremity by intravenous injection of a local anesthetic while the circulation is interrupted. Although the pharmacokinetics of the injected drug is relatively well known, its precise mode of action is still not well understood. The complications of the technique are uncommon and generally minor ones. They occur immediately after tourniquet release. The relative and absolute contra-indications to the use of intravenous regional anesthesia are presented.

Intravenous regional anaesthesia in hand surgery - experience with 632 cases

Practical experience in the use of intravenous regional anaesthesia in hand surgery on 632 patients is reported. The safety of the anaesthesia, the efficacy of the procedure and the patient-comfort are well attested in this study. We recommend that its role should be established particularly in busy orthopaedic surgery departments where both elective and emergency work-loads on hand surgery are heavy.