A comparison of intercuff and single cuff techniques of intravenous regional anaesthesia using 0.5% prilocaine mixed with technetium 99m‐labelled BRIDA

Abstract

SummaryIntravenous regional anaesthesia of the upper limb is a widely used technique first described by Bier in 1908. The exact site of action of injected local anaesthetic has not been determined. We have performed intravenous regional anaesthesia on volunteers using prilocaine mixed with technetium 99m-labelled 2,4,6 trimethyl-3-bromo iminodiacetic acid. Two different techniques of intravenous regional anaesthesia (the 'normal' cuff and the intercuff techniques) were combined with gamma camera tracking of the radiolabel to determine the site of local anaesthetic action. The onset of action was similar for both techniques. The local anaesthetic was mainly retained in the antecubital fossa in both techniques but in the 'normal' technique, the local anaesthetic subsequently showed some retrograde spread. This would suggest that the main site of action of local anaesthetic used for intravenous regional anaesthesia is the larger nerves in the vicinity of the antecubital fossa.

Cisatracurium Pretreatment with Tourniquet - Role in Propofol Injection Pain: A Prospective, Randomized, Double Blind and Control Study

“…16,17 Cisatracurium may reduce propofol injection pain via blockade of peripheral nerve endings followed by blockade of nerve trunks at a proximal site. 18 This study shows that cisatracurium is an acceptable alternative to lidocaine, opioids, ketamine, NSAIDs or other drugs used for propofol induced pain. A major advantage of cisatracurium over other drugs is that cisatracurium is required for muscle relaxation in general anaesthesia, thus avoiding side-effects from additional drugs used for reducing propofol-associated pain.…”

Cisatracurium pretreatment with tourniquet reduces propofol injection pain: A double-blind randomized controlled trial

“…19,[27][28][29] Cisatracurium may therefore reduce propofol injection pain via blockade of peripheral nerve endings by direct diffusion of the local anaesthetic from the vessels into the nearby nerves, followed by blockade of nerve trunks at a proximal site. 30 The findings of the present study indicate a possible pharmacological method to prevent pain from propofol injection, and show that cisatracurium is an acceptable alternative to lidocaine, opioids, ketamine, NSAIDs or other drugs used for this purpose. A major advantage of cisatracurium over other drugs is that cisatracurium is required for muscle relaxation in general anaesthesia, thus avoiding side-effects from additional drugs used for reducing propofolassociated pain.…”

“…19,27–29 Cisatracurium may therefore reduce propofol injection pain via blockade of peripheral nerve endings by direct diffusion of the local anaesthetic from the vessels into the nearby nerves, followed by blockade of nerve trunks at a proximal site. 30…”

Anestesia regional intravenosa primeiro centenário (1908-2008): Início, desenvolvimento e estado atual

“…O esclarecimento da questão tem sido buscado por meio de estudos clínicos e flebográficos, e de medida da condução de impulsos nervosos, com o uso de radioisótopos e tomografia; entretanto, tais pesquisas continuam apresentando resultados discordantes e não conseguiram, até a atualidade, nenhuma conclusão definitiva 3, 75 . Das evidências disponíveis pode-se deduzir que o anestésico local atua fundamentalmente nas terminações nervosas e nos pequenos nervos periféricos e que o bloqueio de troncos nervosos pode ocorrer de forma simultânea, sobretudo quando altas concentrações de anestésico são usadas 3, 75,[128][129][130][131][132] . É possível que a pressão diretamente exercida sobre nervos sensitivos colabore para melhorar a efetividade da anestesia 3, 75 .…”

“…Clinical and phlebographic studies, studies that measure the conduction of nerve impulses, using radioisotopes and CT, have been trying to answer this question; however, their results are contradictory without a definitive conclusion 3, 75 . From the available evidence, one can conclude that the local anesthetic affects mainly nerve endings and small peripheral nerves, and that blockade of nerve trunks can occur concomitantly, especially when high concentrations of local anesthetics are used 3, 75,[128][129][130][131][132] . It is possible that the pressure exerted directly on sensitive nerves collaborates to effectively improve anesthesia 3,75 .…”