Intravenous Regional Anesthesia: A Historical Overview and Clinical Review

Löser, Benjamin; Petzoldt, Martin; Löser, Anastassia; Bacon, Douglas R.; Goerig, M.

doi:10.1016/j.janh.2018.10.007

Cited by 24 publications

(24 citation statements)

References 78 publications

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“…In IVRA, local anesthetics are intravenously administered to one particular limb by occluding the limb proximally to provide conduction blockade. IVRA is a simple and reliable technique that requires little expertise, results in complete and rapid anesthesia, provides a bloodless surgical field, and leads to rapid recovery (1)(2)(3) . This anesthetic technique can be used in the emergency department when a patient is not adequately prepared for general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous regional anesthesia (IVRA) can be safely and effectively applied in minor surgical procedures performed on an ambulatory basis involving both the upper and lower extremities (1,2) . Unlike the brachial plexus block, IVRA does not require expertise or instruments such as the nerve stimulator or ultrasound and can be safely used in patients who are not adequately prepared for general anesthesia (3) .…”

Section: Introductionmentioning

confidence: 99%

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Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

Roychowdhury¹,

Naz²

2021

Jarss

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Objective: Intravenous regional anesthesia (IVRA) is an effective anesthetic technique for surgical procedures of short duration involving the distal parts of the limbs. Intraoperative tourniquet pain is the major restraint of this technique, and to overcome this limitation, various adjuvants to local anesthetics have been used. This study investigated the effect of a fixed low dose of dexmedetomidine as an adjuvant to lignocaine on intraoperative tourniquet pain, onset of block, duration of block, and patient satisfaction. Methods: A total of 100 adult patients with ASA grade I and II who were scheduled for upper limb surgery of approximately 1 hour in duration were randomly divided into two groups (n=50 in each group). Group A received 35 mL of preservative-free lignocaine alone and Group B received 35 mL of preservative-free lignocaine along with 30 μg of dexmedetomidine. The incidence of tourniquet pain, intraoperative fentanyl consumption, duration of onset and recovery of sensory and motor block after tourniquet deflation, postoperative numeric pain rating scale (NPRS) scores, duration of analgesia, and overall patient satisfaction were noted. Result: The incidence of tourniquet pain and intraoperative fentanyl consumption were significantly lower in Group B. The onset and duration of sensory and motor blocks were faster and longer, respectively, in Group B. Postoperative NPRS scores were lower, duration of analgesia was longer, and overall patient satisfaction was better in the dexmedetomidine group. Conclusion: Dexmedetomidine at a dose of 30 μg as a lignocaine adjuvant significantly reduces tourniquet pain and intraoperative fentanyl consumption in IVRA. Dexmedetomidine shortens the onset of block, prolongs the duration of block, and provides a more satisfactory anesthesia than lignocaine alone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

Roychowdhury¹,

Naz²

2021

Jarss

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“…As one well-liked technique fitting for short-term orthopedic surgery, potential IVRA-derived benefits embrace the ease of use, acceptable muscle relaxation, and elevated success rate. 3 4 However, its focal limitation is on the onset and swift development of pain following tourniquet deflation, most notably once operations are prolonged. 3 5 …”

Section: Introductionmentioning

confidence: 99%

“…The toxicity reaction developed after unexpected, accidental tourniquet cuff release during surgery is blamed for being the most severe Bier block complication. 1 4 Because an increased peripheral nerve compression is reported to be accounted for by ischemia following tourniquet inflation, the role of a nerve fibers and non-myelin C-fibers was judged significantly contributory in causing tourniquet pain. 3 5 Varying studies were established to include drugs like morphine, meperidine, magnesium sulfate, fentanyl, sufentanil, clonidine, nitroglycerin, granisetron added to the local anesthetic solution to lengthen the analgesia duration.…”

Section: Introductionmentioning

confidence: 99%

Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries

Moshiri

Modir

Kamali

et al. 2022

Medical Gas Research

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This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n =128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier’s block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.

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“…In 1931, Morrison modified the Bier-technique by using a single-cuff tourniquet and percutaneous venous cannula. Currently used IVRA technique was described in 1963 by Holmes, who administered lidocaine by using a double-cuff tourniquet [2].…”

Section: Introductionmentioning

confidence: 99%

Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

et al. 2021

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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.

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Intravenous Regional Anesthesia: A Historical Overview and Clinical Review

Cited by 24 publications

References 78 publications

Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries

Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

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