Intravenous Regional Anesthesia Research Articles

Length of stay outcomes in patients receiving ketamine sedation versus Bier's block anaesthesia for procedural closed fracture reduction: A retrospective audit of paediatric emergency department patients.

To compare length of stay (LOS) for paediatric patients receiving ketamine sedation or Bier's block anaesthesia for procedural closed fracture reduction. We conducted a retrospective audit of paediatric ED patients aged 3-18 years presenting at one of three metropolitan hospitals in Victoria, Australia (2012-2017). Outcomes were post-procedural LOS (PPLOS), total LOS, incidence of ketamine and Bier's block procedures, and recorded adverse effects. Groups were compared using t-tests. Association between treatment group and admission to a short stay unit (SSU) was assessed using univariate logistic regression. Across all three sites, 449 patients were included, 379 of whom received ketamine sedation and 73 of whom underwent Bier's block anaesthesia. Mean age was 9.1 years (ketamine group: 8.3 years; Bier's block group: 13.1 years). Median PPLOS was 75 min shorter for patients who received a Bier's block than for those sedated with ketamine (P < 0.001). Patients sedated with ketamine were also 9.01 times more likely to be admitted to an SSU than those who received Bier's block anaesthesia (95% confidence interval 3.82-21.31, P < 0.001). Ketamine sedation was more common than Bier's block across the three sites. No major adverse events occurred in either group. Bier's block anaesthesia is a safe alternative to ketamine sedation for paediatric patients presenting to the ED with closed fractures. It is associated with reduced LOS and need for post-procedural observation. However, ketamine may remain preferable for younger paediatric patients, on whom it places fewer demands for cooperation.

Development of novel intravenous regional anaesthetic technique for desensitization of hoof in cattle

The cattle having hoof diseases were selected in the study and divided into 2 groups having 6 animals in each group. For induction of intravenous regional anesthesia, tourniquet was placed circumferentially at the metacarpus and just below dewclaw in group 1 and 2, respectively. Mixture of lignocaine and ketamine (L+K) (4 mg/kg and 3 mg/kg b. wt.) was injected in the radial vein in group 1 animals. However, in group 2 animals the dose of L+K was halved (2 mg/kg and 1.5 mg/kg b. wt.) and injected in the dorsal common digital vein III. The anesthetic potency was monitored by observing the HR, PR, RR, systolic pressure, diastolic pressure and SPO2. In group 1 the heart rate decreased significantly at 10 min interval. Peripheral oxygen saturation significantly decreased up to 60 min and 40 minutes in group 1 and 2 animals, respectively. Systolic pressure significantly increased at 60 minute interval in group 1 animals. After removal of tourniquet, systolic pressure and diastolic pressure was significantly increased in group 2. Sensory and motor block onset time was less in group 2 as compared to group 1. Sensory and motor block recovery time was long in group 2 as compared to group 1 animals. It was concluded that novel IVRA technique was more safe as compared to standard IVRA for the hoof anesthesia in cattle because low doses of local anesthetic are required in this technique with early sensory and motor block, and prolonged effect.

Comparison of intravenous regional anaesthesia with lidocaine and ropivacaine in dogs.

The present study was designed to compare the effects of lidocaine and ropivacaine in intravenous regional anaesthesia (IVRA) in dogs. Twelve adult male dogs were used. Under isoflurane anaesthesia, exsanguination was performed in the target forelimb. Then, a blood pressure cuff was encircled around the limb proximal to the elbow joint with a pressure of approximately 150 mmHg above the mean arterial blood pressure. The animals then received one of the two treatments of lidocaine (3 mg/kg) or ropivacaine (1.5 mg/kg) with a final volume of 0.6 mL/kg into the cephalic vein. After 60 min, the anaesthesia was disrupted and the tourniquet was removed using intermittent opening (30 s) and closing (5 min) manner for three times. The results revealed that at 20 and 30 min after the initiation of IVRA, the dogs in ROP showed higher analgesia than LID. A leakage under the tourniquet during IVRA was detected. Tremor and hypersalivation were observed after tourniquet removal in some dogs. It was concluded that ropivacaine might provide a higher quality of anaesthesia than lidocaine in IVRA in dogs. The development of local anaesthetic toxicity is a major concern and should be considered at the time of tourniquet removal.

Single sterile silicon ring technique for utilization of upper limb intravenous regional anesthesia: A prospective study of patients with operated distal radius fractures

IntroductionIntravenous regional anesthesia is a well-established method of anesthesia in upper extremity surgery. In this study, we present a modification of the technique using a silicon ring tourniquet in 30 patients undergoing internal fixation for distal radius fractures. MethodsA sterile silicone ring wrapped within a stockinette sleeve was applied, and a local anesthetic solution (3 mg/kg lidocaine 0,5%) was injected intravenously. After anesthesia onset, the ring was rolled distally to provide immediate pain and discomfort relief. ResultsThe silicone ring achieved adequate exsanguination in all patients. Mean pain VAS score was 2.7 ± 0.9 intraoperatively and 4.3 ± 1.3 during the first hour postoperatively. The onset and termination times of sensory block were 5.8 ± 2.1 and 102 ± 7.8 min, and of motor block 13.8 ± 2.8 and 54.2 ± 4.6 min, accordingly. All patients were satisfied from the procedure. ConclusionSterile silicone ring tourniquet application is a simple, safe and effective analgesic and anesthetic technique for the operative treatment of distal radius fractures.

QS10: Clinical Practice Patterns and Evidence-based Medicine in Dupuytren’s Contracture: A Twelve-year Review of Continuous Certification Tracer Data From The American Board of Plastic Surgery

Purpose:Since 2008, The American Board of Plastic Surgery (ABPS) has collected clinical practice data on Dupuytren’s contracture repair as part of their Continuous Certification (CC) process. Submitted twice every ten years by each plastic surgeon, this collection can help describe clinical trends in Dupuyren’s contracture repair as they relate to Evidence-Based Medicine (EBM) articles published in this timeframe.Methods:Cumulative tracer data for Dupuytren’s contracture repair from February, 2008 through December, 2014 were reviewed and compared to data from January, 2015 through March, 2020 with the goal of identifying national practice trends. These trends were then evaluated alongside EBM reviews published in 2010, 2014 and 2017.Results:As of March 2020, 230 cases of Dupuytren’s contracture were included in the tracer. The median age at time of surgery was 65 years (range, 38-91 years), and the average age of disease onset was 47 years. The most common surgical technique was limited fasciectomy, comprising 62% of cases. There were no postoperative adverse events reported in 77% of cases. The most common complications were loss of finger flexion (3%) and skin loss (2%). Topics addressed in EBM articles but not tracer data included adjuvant treatments and non-operative techniques such as tamoxifen administration. The use of minimally invasive procedures such as percutaneous cordotomy (0% vs. 13%) and collagenase injections (0% vs. 9%, p = .001) showed significant increases between the two time periods. More invasive procedures such as radical fasciectomy decreased in popularity (34% vs. 16%, p = .002). Use of Z-plasty also decreased between 2015 and 2020 (67% vs. 45%, p < .001). General anesthesia was the most commonly used form of anesthesia, being employed in 54% of tracer cases. There was an increase in the use of Bier block regional anesthesia (1% vs. 9%, p = 0.029) as well as in the use of epinephrine for hemostasis (0 vs. 8%, p = 0.006). Significant changes were also noted in post-operative management, including a decrease in the employment of formal postoperative hand therapy. This is consistent with evidence showing that it has no significant clinical benefit.Conclusion:The tracer data collected on Dupuytren’s contracture repair over a twelve-year period allow us to describe national trends in presentation and surgical techniques, and can help plastic surgeons evaluate their surgical practice in the context of these trends and EBM.

Magnesium Sulfate versus Tramadol as Adjuvants to Lidocaine in Intravenous Regional Anesthesia for Carpal Tunnel Release Surgery: A Randomized Clinical Study

Intravenous regional anesthesia [IVRA] is a simple and effective anesthetic method for providing regional anesthesia of the upper limbs during carpal tunnel release surgery [CTRS]. However, the procedure is associated with significant postoperative pain and adjuvant analgesic agents are recommended.

Effect of intravenous regional anesthesia with spinal block on foot surgeries: A double-blinded randomized clinical trial

Effect of intravenous regional anesthesia with spinal block on foot surgeries: A double-blinded randomized clinical trial

Comparative Study of Lignocaine, Lignocaine with Dexmedetomidine and Lignocaine with Fentanyl for Biers Block in Upper Extremity Surgeries

Background: Dexmedetomidine and Fentanyl have been used effectively along with local anaesthetics to shorten the onset, prolong the duration of the block, and to increase postoperative analgesia. We compared fentanyl and dexmedetomidine as adjuvants to lignocaine for Biers Block for upper extremity surgeries. Materials and Methods: After Institutional approval and informed consent, 90 ASA 1 and 2 volunteers were taken into the study. 30 patients were randomly allocated each in Group A to receive Biers block for upper extremity with 3 mg/kg of 0.5% lignocaine; in Group B, with 3 mg/kg of 0.5 % lignocaine with 0.5 mcg/kg dexmedetomidine and Group C received Biers block of upper extremity with 3 mg/kg of 0.5% lignocaine with 1mcg/kg Fentanyl. The onset of sensory, complete motor block and tourniquet pain were observed and any symptoms after cuff deflation were recorded. Usual haemodynamic monitoring used. Statistical Analysis: ANOVA (Analysis of Variance) and Chi-square tests were used for data analyses; p value of &lt;0.05 considered significant. Results: Groups A, B and C were comparable in demographic and surgical parameters. The speed of onset of sensory and motor block was higher in Group C (Fentanyl) (p &lt;0.0001). The tourniquet pain occurred significantly later in Group B (Dexmedetomidine) (p&lt;0.0001). There were few incidences of bradycardia in Group B. Conclusion: In conclusion, present study suggested that dexmedetomidine and fentanyl will enhance the quality of anaesthesia, providing a shorter onset time of sensory and motor block, delayed first analgesia requirement. Keywords: Biers block; Local Anesthetic: Lignocaine Hydrochloride; a-2 Agonist: Dexmedetomidine; Fentanyl.

The Role of Dexmedetomidine as an Additive to Intravenous Regional Anesthesia: A Systematic Review and Meta-analysis.

Background: Intravenous Regional Anesthesia (IVRA) is a reliable and cost-effective anesthetic method for minor surgical procedures to the extremities. Limitations of this block include tourniquet discomfort, short duration of anesthesia, and absence of postoperative analgesia. Dexmedetomidine has been used as an adjuvant to minimize these negative characteristics with inconclusive results.Aim: To perform a systematic review of the existing evidence on the role of dexmedetomidine as an additive to intravenous regional anesthesia in upper limb surgery.Study Design: Systematic Review and Meta-analysis.Methods: The databases searched were MEDLINE, Embase, PubMed, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials databases, and clinicaltrials.gov (1990-2019). Seven randomized controlled trials (RCTs) were included. We analyzed the duration of analgesia, onset time of sensory and motor block, intraoperative tourniquet pain scores, the incidence of tourniquet pain, need for rescue analgesia, intraoperative rescue analgesia consumption, sedation scores, postoperative pain scores, and anesthesia quality.Results: Intraoperative analgesia duration (MD 11.08 min; 95% CI 5.42, 16.75; P < .0001) was longer and sensory block onset time (MD −2.10 min; 95% CI −3.345, −0.86; P = .00009) was shorter in the dexmedetomidine group. Anesthesia quality scores (MD 0.58; 95% CI 0.47, 0.70; P < .00001) and postoperative sedation scores (MD 1.03; 95% CI 0.88, 1.24; P < .00001) were significantly higher. There was a significant reduction in intraoperative rescue analgesia consumption (MD −19.70 mg; 95% CI −24.15, −15.26; P < .00001) in the dexmedetomidine group. The risk of tourniquet pain as well as postoperative pain scores were lower in favor of dexmedetomidine. The addition of dexmedetomidine to IVRA slightly increased the risk of sedation. A limitation of our study is that some of the interesting outcomes derive from a small number of RCTs.Conclusion: The addition of dexmedetomidine to IVRA ameliorates the block’s characteristics and carries a low risk of potential side effects.

Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

The analgesic efficacy of forearm versus upper arm intravenous regional anesthesia (Bier's block): A randomized controlled non-inferiority trial

Study objectiveThis study aimed to assess if a forearm (FA) intravenous regional anesthesia (IVRA) with a lower, less toxic, local anesthetic dosage is non-inferior to an upper arm (UA) IVRA in providing a surgical block in patients undergoing hand and wrist surgery. DesignObserver-blinded, randomized non-inferiority study. SettingOperating room. Patients280 patients undergoing hand surgery were randomly assigned to UA IVRA (n = 140) or FA IVRA (n = 140). InterventionsForearm IVRA or upper arm IVRA in patients undergoing hand and wrist surgery. MeasurementsThe primary outcome was block success rate of both techniques. Block success was defined as no need of additional analgesics. A second, alternative non-inferiority outcome was defined as no need of conversion to general anesthesia. A difference in success rate of <5% was considered non-inferior. Secondary endpoints were tourniquet pain measured with a Numerical Rating Scale (0−10), satisfaction of patients and surgeons, onset time, surgical time and total OR time. Main resultsNon-inferiority of block success rate, defined as no need of additional analgesics or conversion to general anesthesia was inconclusive (5.24%, 95% CI:-4.34%,+14.82%). Non-inferiority of no need of conversion to general anesthesia was confirmed (+0.73%, 95% CI:-0.69%,+2.15%). No differences were observed in onset time (FA: 5 (5, 8) vs UA: 6 (5, 7) min, p = 0.74), surgical time (FA: 8 (5, 12) vs UA: 7 (5, 11) min, p = 0.71), nor total OR stay time (FA: 34 (27, 41) vs UA: 35 (32, 39) min, p = 0.09). Tourniquet pain after 10 min was significantly lower after FA IVRA compared to UA IVRA (FA: 2.00 (0.00, 4.00) vs UA: 3.00 (1.00,5.00) min, p = 0.003). ConclusionWe failed to demonstrate non-inferiority of forearm IVRA with a lower dosage of LA in providing a surgical block without rescue opioids and LA. Non-inferiority of no need of conversion to general anesthesia was confirmed.

The effect of wide-awake anesthesia, intravenous regional anesthesia, and infraclavicular brachial plexus block on cost and clinical scores of patients undergoing hand surgery

The aim of our study was to compare the clinical results and costs of wide-awake local anesthesia no tourniquet (WALANT), intravenous regional anesthesia (IVRA), and infraclavicular brachial plexus block (IC-BPB). The patients were divided into WALANT, IVRA, IC-BPB groups, each with 50 patients. Demographic information, induction time, use of sedation, number of patients who were converted to general anesthesia, time in postanesthesia care unit (PACU), amount of bleeding during surgery, presence of tourniquet pain, hand motor function during surgery, time to onset of postanesthesia pain, discharge time, complications, and anesthesia costs were compared. Sedation was given to 12 IC-BPB patients, 9 IVRA patients and 5 WALANT patients. Of these patients, 6 undergoing IC-BPB, 5 undergoing IVRA and 4 undergoing WALANT were converted to general anesthesia (p = 0.80). PACU time and anesthesia costs were the least in the WALANT group, followed by the IVRA group (p < 0.001, p < 0.001). Intraoperative active voluntary movements were best preserved in the WALANT group; however, bleeding was highest in the WALANT group (p < 0.001, p < 0.001). Tourniquet pain was the higher in the IVRA groups, while postoperative pain in the surgical area developed the fastest in this same group (p = 0.029, p < 0.001). Time to discharge was similar in WALANT and IVRA groups, and the longest in the IC-BPB (p < 0.001) group. There was no difference among the groups in terms of patient satisfaction (p = 0.085, p = 0.242 for the first and second survey question). In the current study, WALANT appears to be a suitable alternative to IVRA and IC-BPB methods, with better preservation of active intraoperative movement, lower cost, and shorter time spent in PACU at the expense of higher bleeding.

TO COMPARE THE EFFECTS OF ROPIVACAINE(1.8mg/kg) WITH FENTANYL (50μg) AND ROPIVACAINE (1.8mg/kg) WITH CLONIDINE (75μg) FOR INTRAVENOUS REGIONAL ANAESTHESIA (IVRA) FOR UPPER LIMB AND LOWER LIMB SURGERIES

Introduction: Intravenous Regional Anaesthesia (IVRA) is indicatedfor short surgical procedures of upper extremity(below elbow) and of lower extremity (below knee). The aim of this randomised double-blind controlled study was to investigate the effects of adding Injection Clonidine as adjuvant to Injection Ropivacaine and Injection Fentanyl as adjuvant to injection Ropivacaine for IVRA in patients undergoing upper limb (below elbow) and lower limb (below knee) surgeries. Sixty adult ASA I and II patients Material and methods: of either sex in the age range of 20 to 60 years were randomly divided equally into 2 groups of 30 each. Group A received Injection Ropivacaine(0.75%) 1.8 mg/kgwith Injection Clonidine75µg/kg and Group B received Injection Ropivacaine (0.75%) 1.8 mg/kg with Injection Fentanyl 50 µg/kg. Results: Sensory onset showed high statistically signicant difference with Group A having earlier onset at 28.50 19.96 seconds as compared to Group B at 238 111.95 seconds (P&lt;0.0001). Comparison of peak sensory showed high signicant statistical difference with Group A having earlier onset at 194 223.21 seconds as compared to Group B at 720 217.19 seconds (P&lt;0.0001). The sensory wearoff between both the groups were highly signicant statistically showing Group A at 1150 ± 486.19 seconds as compared with Group B 184 ± 112.45 seconds (P&lt;0.0001). The Visual Analogue Score in post operative ward just after completion of surgery show Group B having higher VAS score as compared with Group A.The time for rescue analgesia was prolonged in Group A as compared with Group B. Conclusion: Adding Clonidine to Ropivacaine improved the quality of anaesthesia and post-operative analgesia in Intravenous Regional Anaesthesia as compared to when Fentanyl was added to Ropivacaine.

Open Carpal Tunnel Release Under WALANT – Suitable for All Ages?

PurposeWide-awake local anesthesia with no tourniquet (WALANT) as a walk-in procedure has become a standard technique in open carpal tunnel release (OCTR) and continues to replace the long-established intravenous regional anesthesia with a tourniquet (IVRA/”bier-block”) in our clinic. The aim of this study was to compare patient satisfaction with either WALANT or IVRA/”bier-block” and define subgroups that are particularly suited for either of the two procedures. We hypothesized that older patients would prefer IVRA because of a shorter period of postoperative surveillance.MethodsIn this retrospective study we evaluated patient satisfaction with either WALANT or IVRA using an adjusted questionnaire on a standard Swiss grading system (from 1 = insufficient/very strong pain to 6 = excellent/no pain). Secondary outcomes included postoperative pain or satisfaction with the tourniquet and quality of postoperative care.ResultsFor the 176 patients (WALANT, n = 109; IVRA, n = 67) included in the study, there was high patient satisfaction with both procedures (WALANT, 5.5/6; IVRA, 5.5/6). Patients aged 80 years and older had significantly less postoperative pain after WALANT (WALANT, 5.8/6 vs IVRA, 4.9/6).ConclusionsPatients aged 80 years and older had significantly less postoperative pain after WALANT than that after IVRA. Here, sarcopenia may have contributed to the prolonged discomfort after tourniquet application. Immediate postoperative discharge after WALANT did not negatively affect older patients.Clinical relevanceFor OCTR, WALANT as a walk-in procedure is a safe and comfortable alternative to IVRA, which is commonly planned with short postoperative surveillance. Both anesthesia techniques are suitable for all ages and sexes but based on this study we recommend WALANT as a tourniquet-free operation in older patients.

Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial.

Background and objectivesDistal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release.MethodsIn this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1.ResultsIn total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block.ConclusionAn ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release.Trial registrationThis trial was registered as NCT03411551.

Anesthetic care influences long-term outcomes: What is the evidence?

Despite advances in cancer therapy surgery remains one of the most important treatments for solid tumors; however, even with the development of better and less invasive surgical techniques, surgery is characterized by the increased risk of tumor metastasis, accelerated growth of pre-existing micrometastasis and cancer recurrence. Total intravenous anesthesia (TIVA) and regional anesthesia have been proposed to improve long-term outcomes after cancer surgery by different mechanisms, including attenuation of the neuroendocrine response, immunosuppression, decreased opioid requirements (opioids promote angiogenesis and tumor growth) and avoidance of volatile inhalational agents. Much of the data that support these ideas originate from laboratory studies, while there is no clear consensus from the retrospective cohort studies to date. Several randomized controlled trials (RCTs) are in progress and may provide a better understanding regarding the role of the anesthesiologist in cancer surgery. The purpose of this review is to summarize the experimental and human data regarding the effect of anesthesia agents and anesthesia techniques on cancer outcomes.

Dexmedetomidine as an Adjunct for Regional Anesthetic Nerve Blocks.

This article will review current evidence related to the use of dexmedetomidine as an adjuvant for regional anesthesia. Adjuvants, frequently used during regional anesthesia, act synergistically with local anesthetics thus enhancing the quality of regional anesthesia while minimizing adverse effects. These adjuvants may be administered via different routes including topical, perineural, neuraxial, and systemic. Recent studies indicate that dexmedetomidine prolongs the duration of intravenous regional anesthesia, peripheral nerve blocks, and spinal analgesia. Controversy regarding potential neurotoxicity of perineural dexmedetomidine in patients with diabetic neuropathy requires further evaluation.

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

Objective: 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 all-time 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.

Resurgence of combined intravenous Ketamine and regional anesthesia in pediatric ocular surgery in COVID-19 pandemic

Purpose:The current pandemic of COVID-19 has made airway procedures like intubation and extubation, potential sources of virus transmission among health care workers. The aim of this work was to study the safety profile of combined ketamine and regional anesthesia in pediatric ocular surgeries during the COVID-19 pandemic.Methods:This prospective study included pediatric patients undergoing ocular surgery under general anesthesia from April to October 2020. Children were premedicated with oral midazolam (0.25–0.50 mg/kg) or intramuscular ketamine (7-10 mg/kg), ondensetron (0.1 mg/kg) and atropine (0.02 mg/kg). Anesthesia was achieved with intravenous ketamine (4–5 mg/kg) and local anesthesia (peribulbar block or local infiltration). The patient's vital signs were monitored. Serious complications and postoperative adverse reactions related to anesthesia were documented.Results:A total of 55 children (62 eyes) were operated. Lid tear was the most common surgical procedure performed [n = 18 (32.7%)]. Dose of ketamine needed ranged from 30 to 120 mg (66.67 ± 30.45). No intubation or resuscitation was needed. Four children complained of nausea and two needed an additional dose of intravenous ondansetron due to vomiting in the post-operative period. Incidence of postoperative nausea and vomiting was not affected by age, duration of surgery or dose of ketamine used (P > 0.05). There was no correlation between increase in pulse and dose of ketamine.Conclusion:Combined ketamine and regional anesthesia is a safe and effective alternative to administer anesthesia in a child during ocular surgeries.

Dexmedetomidine with 0.5% lignocaine enhances postoperative analgesia in patients undergoing upper limb orthopedic surgeries under intravenous regional anesthesia

Background: Intravenous regional anesthesia (IVRA) is an effective technique to provide analgesia for upper limb surgeries of shorter duration. Various adjuvants are used with local anesthetics to prolong the duration of analgesia. This study was undertaken to establish the effect of dexmedetomidine with lignocaine for IVRA in upper limb orthopedic surgeries. Materials and Methods: Sixty patients aged 15 to 65 years of either sex belonging to the American Society of Anesthesiologists (ASA) physical status I and II undergoing upper limb orthopedic surgeries were enrolled. Group L (n = 30) received lignocaine 2%, 7.5 mL diluted to total volume of 30 mL using normal saline while Group LD (n = 30) received lignocaine 2%, 7.5 ml with dexmedetomidine 1 μg/kg dilu ted to total volume of 30 mL using normal saline in IVRA. The onset of sensory and motor block, recovery of sensory and motor block, duration of analgesia, hemodynamics, and adverse effects were noted. Results: The mean onset time of sensory block was significantly faster in Group LD (3.50 ± 0.41 min) than Group L (6.67 ± 0.65 min); P 0.05. Conclusion: Dexmedetomidine (1 μg/kg) in IVRA leads to faster onset of sensory and motor block, prolonged duration of analgesia with better hemodynamic stability and minimal side effects.