No abstract

Aim: Intravenous regional anesthesia (IVRA) is not commonly preferred in the lower extremity because of the toxic risks of high-dose local anesthetics. This study aimed to compare the use of two different concentrations of anesthetics with additional tourniquet application to reduce local anesthetics amount during the IVRA method for short-term foot and ankle surgeries. Material and Methods: In this prospective study, 40 patients were allocated to two groups with different concentration formulations of 200 mg lidocaine hydrochloride (Group 30 and Group 20). The groups were compared in terms of demographic data, tourniquet pain, operation time, hemodynamic indicators, and sedo-analgesia needs. Results: Demographic data were similar in the two groups. The mean tourniquet pain time was 41.66±6.61 minutes in Group 20 (n=9) and 36.76±7.17 minutes in Group 30 (n=13) (p=0.120). Perioperative sedo-analgesia consumptions were similar between the groups: weight-adjusted before/after tourniquet pain (p=0.390, p=0.207, p=0.536, and p=0.176), weight-adjusted/none total amount (p=0.425, p=0.578, p=0.268, and p=0.612), per minute before/after tourniquet pain (p=0.075, p=0.506, p=0.354, and p=0.055), for propofol and remifentanil, respectively. There was a significant difference between the propofol and remifentanil consumption per minute before and after the tourniquet pain in both groups: 5.61±1.67 and 14.58±6.62 mg/min propofol (p=0.001), and 4.79±1.69 and 7.86±1.55 mcg/min remifentanil (p=0.001), respectively. No patient had signs of local anesthetic toxicity. Conclusion: Low-dose sedo-analgesia can be used by a modified IVRA method in the management of tourniquet discomfort that may occur until the tourniquet pain develops.

Modified approaches are emphasized to make the traditional IVRA method more reliable and effective. We aimed to compare two different concentrations used with temporary tourniquet application in addition to the IVRA method for reducing local anesthetics amount in hand and wrist surgeries. Material and methods: After the approval of Gaziantep University Ethics Committee had been obtained, observation forms of patients with ASA physical score I-II who had undergone elective orthopedic upper extremity surgery were reviewed retrospectively. The patients were divided into two groups according to the concentration of 150 mg of lidocaine in saline. The patients were administered 150 mg lidocaine in 15 ml (Group 15, n:29) and 20 ml (Group 20, n:26) saline. Patients were enrolled into groups in a random and a blind fashion, and after the exclusion criteria were assessed, twenty patients from each group were evaluated. Demographic data, the classification of operation time, the peri-operative follow-up values, the sedoanelgesia consumption needs and the postoperative patient satisfaction scores were compared. Results: Demographic data were similar in both groups. The tourniquet time was 40.75±14.71 minutes in Group 15 and 38.25±9.77 minutes in Group 20 (p=0.531). Sedation start time was 23.18±9.02 in Group 15 (n=11) and 26.53±6.57 minutes in Group 20 (n=13) (p=0.304). Tourniquet pain time was 46.66±2.88 in group 15 (n=3) and 50.00±7.07 minutes in group 20 (n=2) (p=0.624). No statistically significant difference was found between the alltime classifications, hemodynamic values, peri-operative sedoanalgesia consumptions, and the patient satisfaction scores between the groups (p>0,05). A continuous increase in sedoanalgesic consumption amount with time was observed. None of the patients had signs of local anesthetic toxicity. Conclusion: We suppose that the plasticity inherent to the IVRA may be optimized by alternative adaptations to be used for decreasing the amount of local anesthetic to safer levels and for reducing the risk of related side effects.

Intravenous Regional Anesthesia (IVRA) was modified many times since its first use and these changes continue according to the type of surgery. A 36-year-old male patient was operated for trigger finger in the fascia of the first and second carpal bones. Because of the short operation time and for early detection of possible vascular or nerve damage after surgery, the IVRA method was used with the forearm tourniquet containing contrast agent. Forearm tourniquet can be preferred in short-term hand surgeries due to its advantages such as easy application, low side effect profile and early block recovery.

No abstract