Forearm Intravenous Regional Anesthesia Research Articles

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 feasibility of using forearm intravenous regional anaesthesia instead of the standard upper arm technique in wrist and hand surgery

Aim of the study: to compare between the efficacy of using forearm intravenous regional anesthesia (IVRA) and upper arm IVRA and investigate the effects of nitroglycerine (NTG) compared to fentanyl when added to lidocaine in IVRA in wrist and hand surgery. Patients and Methods: 100 patients divided into 4 equal groups. Patients had upper arm tourniquet and received lidocaine (3 mg/kg) mixed with fentanyl (1 μg/kg) in Group I and NTG (400 μg) in Group III. Patients had forearm tourniquet and received half dose of the aforementioned drugs in Group II and Group IV. Results: there was a rapid sensory and motor block onset and reduction in postoperative diclofenac requirement in group III and group IV compared to group I and group II. Conclusion: Both forearm and upper arm tourniquets showed comperable results. Nitroglycerin was associated with rapid onset of sensory and motor block, and reduction in postoperative diclofenac requirement.

The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

BackgroundThe main objective of this review is to perform a systematic review and meta-analysis of the existing evidence related to the analgesic efficacy with the use of conventional, upper arm intravenous regional anesthesia (IVRA) as compared to a modified, forearm IVRA in adult patients undergoing procedures on the distal upper extremity.MethodsMEDLINE, EMBASE and CENTRAL (Cochrane) databases were searched for randomized controlled trials published in English, French, Dutch, German or Spanish language. Primary outcomes of interest including description of quality level of anesthesia and onset of sensory block were assessed for this review. Dosage of the local anesthetic, local anesthetic toxicity and need for sedation due to tourniquet pain were considered as secondary outcomes.ResultsOur literature search yielded 3 papers for qualitative synthesis. Four other articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA. Forearm IVRA was found to be as efficient as upper arm IVRA (RR = 0.98 [0.93, 1.05], P = 0.78), but comes with the advantage of a lower need for sedation due to less tourniquet pain.ConclusionOur results demonstrate that forearm IVRA is as effective in providing a surgical block as compared to a conventional upper arm IVRA, even with a reduced, non-toxic dosage of local anesthetic. No severe complications were associated with the use of a forearm IVRA. Other benefits of the modified technique include a faster onset of sensory block, better tourniquet tolerance and a dryer surgical field.Registration of the systematic reviewA review protocol was published in the PROSPERO register in November 2015 with registration number CRD42015029536.

Efficacy of forearm intravenous regional anesthesia through comparison of concentration and volume of lidocaine at a dose of 2 mg/kg for hand and wrist surgeries

Aim This study aimed to evaluate the efficacy of intravenous regional anesthesia (IVRA) as regards volume versus concentration of lidocaine in surgeries. Patients and methods The study enrolled 46 patients of ASA physical status I and II, aged 18-65 years, undergoing IVRA using lidocaine 2% at a dose of 2 mg/kg plus fentanyl 1 mg/kg diluted with a volume of 25 ml normal saline [the concentration group (group C, n = 23)], or 2 mg/kg lidocaine 2% plus fentanyl 1 mg/kg diluted with a volume of 40 ml normal saline [the volume group (group V, n = 23)]. The total supplemental systemic fentanyl intraoperatively and rescue pethidine consumption during the first 4 h postoperatively were recorded. The success rate of the IVRA block was also recorded. First and second tourniquet pain times, as well as times of onset and recovery of sensory and motor block, were calculated. Visual analogue scale score for evaluation of the pain resulted from the surgical stimulation was recorded. The side effects of the drugs and complications of the technique were also recorded. Results Intraoperative supplemental fentanyl dose was significantly higher in group V compared with group C. The total pethidine consumption during the first 4 postoperative hours showed nonsignificant difference between patients of the two groups, with a mean of 48.27 ± 9.75 mg in group C versus 52.42 ± 13.83 mg in group V. Hemodynamic parameters such as heart rate and mean arterial pressure were comparable in the two groups. The time to first call of analgesia was significantly prolonged ( P Conclusion IVRA with lidocaine at a dose of 2 mg/kg in 25 ml volume of normal saline represented an effective block and reduced the second tourniquet pain, increased the second tourniquet tolerance, and significantly decreased intraoperative supplemental fentanyl in comparison with the same dose in 40 ml volume of normal saline.

Bilateral forearm intravenous regional anesthesia with prilocaine for botulinum toxin treatment of palmar hyperhidrosis

Treatment of palmar hyperhidrosis with botulinum toxin (BTX) requires effective anesthesia, but previous methods have not provided enough pain relief or have resulted in a prolonged impaired hand function. This is a study of bilateral forearm intravenous regional anesthesia using prilocaine for BTX treatment of palmar hyperhidrosis. In all, 166 patients (100 female and 66 male) were treated bilaterally with intracutaneous BTX type A injections using intravenous regional anesthesia with prilocaine (5 mg/mL). In a subgroup of patients, forearm nerves were studied with neurophysiologic methods and blood concentrations of prilocaine were measured. Pain evaluation with a visual analog scale was accompanied with a questionnaire about the treatment. In all, 95% of the patients answering the questionnaire (response rate 89%) were satisfied with the anesthetic effect. No serious adverse events occurred. There was a fast recovery of motor function (in median 6 minutes) and sensory function (in median 20 minutes). No subclinical signs of sensory nerve damage were found. Recall and reporting bias are potential sources of limitations in this study. Bilateral forearm intravenous regional anesthesia provides an effective and well-tolerated anesthesia during BTX treatment of palmar hyperhidrosis.

Comparing the Effectiveness of Modified Forearm and Conventional Minidose Intravenous Regional Anesthesia for Reduction of Distal Forearm Fractures in Children

Minidose intravenous regional anesthesia (IVRA) and modified forearm IVRA have been used for closed reduction of forearm fractures and for hand surgery in children. Children (5-17 years old) with forearm fractures presenting to a pediatric emergency department were enrolled in a randomized controlled trial to test if modified forearm and minidose IVRA together would provide improved analgesia with reduced risk of anesthetic toxicity compared with conventional minidose IVRA. Pain was assessed using a visual analog scale (FACES) and an objective pain scale (OPS) score at baseline and at critical times. Spearman rank correlation and repeated-measures analysis of variance were used to compare interobserver pain measures and detect differences between the groups over time. Among the 62 patients in the study, no significant differences were observed between groups in objective measures of blood pressure, oxygen saturation, and heart rate at baseline, 5 minutes after IVRA, during surgical reduction, and 15 minutes after reduction. Nurses reported patients experienced a reduction in pain of 2.5 (SD, 3.1) on FACES and 2.3 (SD, 3.1) on OPS at 5 minutes after sedation (P < 0.001 for both). From time of reduction to 15 minutes after the procedure, FACES score declined 1.7 (SD, 3.4) (P = 0.001), and OPS declined 2.1 (SD, 3.6) (P = 0.002). No significant differences were found between experimental arms. The modified forearm minidose IVRA procedure is an acceptable alternative for the relief of pain that usually accompanies the manipulation and reduction of forearm fractures but does not appear to provide additional pain relief compared with conventional minidose IVRA. Level I, therapeutic study.

Bilateral forearm intravenous regional anesthesia (IVRA) with prilocaine for botulinum toxin treatment of palmar hyperhidrosis

Treatment of palmar hyperhidrosis with botulinum toxin (BoNT) requires effective anesthesia. Previous methods have not provided enough pain relief or have resulted in impaired hand function several hours after treatment. IVRA is an effective and well-documented method for hand surgical procedures. This is the first study of bilateral forearm IVRA using prilocaine for BoNT treatment of palmar hyperhidrosis. The study involved 166 patients treated bilaterally with intracutaneous BoNT type A injections. The anesthetic effect, recovery after treatment and side effects of IVRA were studied. In a subgroup of patients, sensory nerve action potentials and thermal thresholds were measured to investigate subclinical signs of damage to peripheral nerves. Patients’ experience and comments were registered during treatment and in a questionnaire. Bilateral forearm IVRA provided good or excellent pain relief during treatment in 95% of the respondents to the questionnaire. No serious events requiring assistance or discontinuation of treatment occurred. After treatment, recovery of motor and sensory function was fast. The main complaint was discomfort or pain from the tourniquet cuff. No subclinical signs of nerve damage were found. In conclusion, bilateral forearm IVRA provides a safe and effective anesthesia during BoNT treatment of palmar hyperhidrosis.

Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia

Background and Objectives: Ropivacaine was shown to provide superior postblock analgesia to lidocaine in intravenous regional anesthesia (IVRA) in voluntary studies. The objective of this study was to compare the anesthesia efficacy, postblock analgesia, and local anesthetic-related side effects between ropivacaine and lidocaine when forearm IVRA was used. Methods: Fifty-one patients undergoing outpatient hand surgery were randomized to receive forearm IVRA with either ropivacaine 0.375% or lidocaine 0.5%. The volume was 0.4 mL/kg up to 25 mL. Sensation to pinching by forceps and motor function was assessed at 5-minute intervals up to 15 minutes. After tourniquet deflation, verbal pain rating score (VRPS) at 15-minute intervals for the first 2 hours and time for first analgesic in the first 24 hours were evaluated. Results: Eleven patients were excluded from the study with 20 patients remaining in each group. Onset time of anesthesia (6.5 ± 2.9 minutes v 8.0 ± 4.1 minutes for lidocaine and ropivacaine groups, respectively) and motor block were similar. In the postoperative period, VPRS was significantly lower in the ropivacaine group in the first 60 minutes (median, 0; P < .05) with significantly more patients in the ropivacaine group pain free (VPRS, 0) up to the first 90 minutes (P > .05). More patients in lidocaine group requested analgesic in the first 2 hours postblock, and only patients in the lidocaine group required supplemental IV morphine in the recovery room. Twenty-four hour analgesic consumption was the same. No local anesthetic-related side effects were observed. Conclusions: We conclude that 0.375% ropivacaine provides effective anesthesia and superior postoperative analgesia compared with 0.5% lidocaine when forearm IVRA is used. Reg Anesth Pain Med 2002;27:595-599.

Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia

Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia