The effects of simulated Bier block IVRA on intracompartmental tissue pressure.

Abstract

Intravenous regional anesthesia (IVRA) is a useful anesthetic method for closed reduction of fractures. However, IVRA has been associated with an increased incidence of compartment syndrome when treating tibial shaft fractures. The purpose of this study was to measure changes in anterior leg compartment pressures during simulated IVRA. A volunteer study was performed. An indwelling catheter placed in a consistent location between subjects was used to measure tissue pressure. A vinyl leg splint was used for exsanguination followed by thigh tourniquet inflation (300 mmHg). Normal saline (1.5 mL/kg) was injected through the greater saphenous vein (1.0 mL/s). Pressure measurements were obtained before and after tourniquet inflation, at 10 mL increments during saline injection, and intermittently after volume injection with the tourniquet inflated, then deflated. There was no significant difference in tissue pressure before (2.4 +/- 2.2 mmHg) and after (4.3 +/- 3.7 mmHg) tourniquet inflation (P = 0.11). No significant difference in tissue pressure were found as a function of injected volume (P = 0.62), as a function of time following saline injection during tourniquet inflation (P = 0.08), and after tourniquet deflation (P = 0.16). We conclude that in the normal atraumatic limb, simulated IVRA using normal saline does not increase tissue pressure within the anterior leg compartment.