Intravenous Regional Analgesia: an Appraisal

Abstract

Carcinoma of Bronchus-Beicher and Anderson MEDICAL URANeither the operative mortality nor the survival rate had changed significantly during the 15 years. The survival rate was not affected by the proportion of lobectomies among the resections, although this had risen considerably during the 15 years.There was some correlation between the five-year survival rate and the resection rate. REFERENCES Barrett, R. J., Day, J. C., O'Rourke, P. V., Chapman, P. T., Sadeghi Adams, 1944) that the intravascular injection of a local anaesthetic agent was associated with analgesia in the area supplied by that vessel, this knowledge was not put to practical use until Bier (1908) published his account of venous anaesthesia for limb surgery. His method achieved considerable popularity in the next few years, and its use was widely reported.Bier's technique, though effective, was cumbersome, and although an improvement in the form of a single-tourniquet method was described by Morrison (1931) few were then employing venous anaesthesia in this country. The subject was well reviewed by Adams (1944), but the credit for the reintroduction of the "technique" undoubtedly goes to Holmes. His series consisted chiefly of relatively short operative procedures of a type suitable for the casualty department. Our aims in the present trial were twofold: (1) to assess the suitability of the method for more extensive limb surgery, and (2) to investigate the incidence and nature of lignocaine toxicity phenomena occurring after release of the tourniquet. Materials and MethodThe technique described by Holmes was used. An indwelling needle was inserted in a vein before application of an Esmarch bandage and tourniquet. After exsanguination of the limb lignocaine was injected.Patients due for peripheral limb surgery were interviewed, and, after explanation of the method, were asked whether they would agree to have their operation performed under analgesia of this type. Premedication, usually with an appropriate dose of papaveretum and hyoscine, was given in over three-quarters of the cases. Plate electrodes were attached to each limb in the anaesthetic room and connected to a direct-writing E.C.G. machine. A von Recklinghausen oscillotonometer cuff was put on the arm not scheduled for surgery and the systolic bloodpressure recorded. Difficulty was occasionally experienced through Gordh needles becoming dislodged from veins during application of the Esmarch bandage; polyvinyl chloride catheters inserted through a Macgregor (1960) introducing needle or fine-gauge Intracaths were occasionally used. After injection of the lignocaine and positioning the patient standard lead E.C.G. tracings were obtained. During surgery the bloodpressure was recorded by the oscillotonometer on at least four occasions.After completion of surgery the tourniquet was deflated and an E.C.G. tracing begun: this ran for two and a half minutes. or longer if any irregularity was noticed. The blood-pressure was recorded at half-minute intervals during this period, and the appearanc...

Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications

“…Cardiac arrests and deaths were reported in 13 patients and only with lidocaine and bupivacaine [24][25][26][27][28][29][30][31]. The lowest dose associated with a cardiac arrest was 2.5 mg/kg for lidocaine and 1.6 mg/kg for bupivacaine.…”

Blocks at the wrist provide effective anesthesia for carpal tunnel release

“…Early deflation of the tourniquet has been associated with seizures or cardiac arrhythmias related to systemic local anesthetic toxicity. 5,19 As indicated by the percentage of blocks requiring a second injection at ten minutes, it seems that the technique described was adequate to produce median and musculocutaneous blocks. However, we encountered a high degree of failure following ulnar injection, with 31% of patients requiring a second injection to produce a complete ulnar block; this result indicates that the ulnar block technique was not optimum.…”

“…Although general anesthesia is still often used for patients undergoing distal upper extremity surgeries, local infiltration either alone [1][2][3] or combined with sedation, 4 iv regional anesthesia, 5 brachial plexus blocks, [6][7][8] and distal blocks at the wrist 9 also seem to be indicated. For limited procedures such as endoscopic carpal tunnel release, which are mostly performed on an outpatient basis and sometimes even as an office procedure, it seems that distal blocks at the wrist should be especially appropriate.…”

Local and Regional Analgesia

“…To obviate pain from the sphygmomanometer cuff, a second cuff may be applied at a lower level over an area already rendered analgesic by the injection. Untoward reactions will occur if the cuff is released within 10 minutes of the injection, and recently it has been suggested (Kennedy, Duthie, Parbrook and Carr, 1965) that these may also occur much later. Fa!inting, dizziness and the cardiac arrhythmias reported can hard'ly be dismissed, but it is surprising that so many other workers have testified to the safety of the method and its lack of sequelae (Sorbie and Chacha, 1965;van Niekerk and Tonkin, 1966).…”