Objective: To compare the efficacy and safety of the addition of Cisatracurium to Lignocaine versusplain Lignocaine for IVRA. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2023. Methodology: Forty-four patients undergoing elective hand surgery were randomly assigned to two groups of 22 patients each. All demographic details were noted, all were briefed about VAS (0 to 10) for pain. Group 1 received Lignocaine 2%; Group 2 received Cisatracurium plus Lignocaine 2%. Standard technique was employed for IVRA. Following were assessed: onset and offset of sensory and motor block, quality of anesthesia using a numerical scale scored 1-4, postoperative pain using VAS measured at 5-minute,1, 2, 4, 8 hours and the time to first analgesic request. Results: The onset times of sensory & motor blocks were significantly shorter (p=0.001 & p<0.001) and the regression times of sensory & motor blocks were prolonged (p=0.003 & p<0.001) in group B compared with the group A. The Cisatracurium group had better quality of anesthesia (p<0.001). Overall, lower mean VAS pain scores were recorded after tourniquet deflation and longer time to the first analgesic request (p<0.001) was recorded in Cisatracurium group post-operatively. Conclusion: The addition of Cisatracurium to Lignocaine in IVRA, shortened the block onset times, prolonged the block offset times, improved the quality of anesthesia & decreased the post-operative pain & time to first analgesic requirement.

This study evaluated tears and saliva as alternatives to blood for determining cortisol concentration in healthy and chronically lame Merino meat sheep with dermatitis interdigitalis contagiosa (DINCO). Twelve healthy (HEALTHY) and 36 sheep with DINCO were included. After enrollment and placement of a jugular vein catheter on day 0, sheep underwent daily clinical examination and tear, saliva, and blood sampling on days 1 to 6 to determine cortisol concentrations (tears: COT; saliva: COS; blood: COB). After a 4-day adaptation period, blood and tears were collected six times at defined intervals immediately after the application of standardized stressors during a 1-h treatment phase. Sheep with DINCO were randomly allocated to one of three treatment groups and underwent claw treatment with or without pain control: the XYLA-IVRA group received sedation and retrograde intravenous regional anesthesia (IVRA); the IVRA group underwent IVRA and received a placebo instead of sedation; the PLACEBO and HEALTHY groups received isotonic saline instead of sedation and IVRA. The HEALTHY group underwent sham claw treatment. Statistical analyses used linear mixed models (PROC MIXED, SAS 9.4). Saliva and tear collection was minimally invasive, repeatable, and consistently yielded sufficient material for analysis without adverse health effects. Cortisol was detected in saliva and tears at all time points, and concentrations did not differ between healthy and diseased sheep during the adaptation phase. Both matrices had lower concentrations than blood but correlated positively and significantly with each other (day 2, R = 0.86 ± 0.05) and with COB (RCOB−COS = 0.71 ± 0.1, RCOB−COT = 0.61 ± 0.1). During the treatment phase, the COT increased in response to stressors similar to COB, albeit with a median delay of 6 min. The COT tended to be higher in the PLACEBO than in the XYLA IVRA group. Considering the time delay, saliva and tears are reliable, minimally invasive collected alternatives to blood for determining cortisol concentrations and assessing an acute stress response in healthy and chronically lame sheep.

Carpal dislocations are rare but serious injuries, sometimes occurring in isolation or in association with distal radial fractures. These complex injuries carry high risks of long-term dysfunction and require timely and standardised management. In 2017, the British Orthopaedic Association (BOA) and British Society for Surgery of the Hand (BSSH) published consensus guidelines to address wide variations in care and outcomes. This audit evaluated adherence to BOA/BSSH guidance at a tertiary trauma centre. 80 patients with extra-articular distal radial fractures and carpal dislocations were retrospectively identified (October 2022-March 2023). A structured checklist based on BOA/BSSH recommendations was applied, focusing on documentation, anaesthesia, timing of surgery, immobilisation, and Postoperative care. Mean age was 38.2 (±13.7) years, and 76/80 (95.0%) patients underwent surgical management. Only 4/37 (10.8%) patients with available anaesthesia data received intravenous regional anaesthesia as recommended. Mean immobilisation time was 8.2 (±2.6) weeks, exceeding the 4-week standard. Surgery within 1 week occurred in 34/76 (44.7%). No cases documented a neurovascular assessment. At 6 months, 22/80 (27.5%) reported ongoing stiffness and 40/80 (50.0%) required hand therapy. Adherence to BOA/BSSH guidelines was poor, particularly for anaesthesia choice, immobilisation duration, and surgical timing. This may have contributed to mediocre outcomes. As current standards are primarily designed for DRFs rather than CDs, their direct application to these complex cases should be interpreted cautiously. Nonetheless, improved documentation, anaesthesia practice, and adherence to early mobilisation protocols represent clear opportunities for service improvement.

Practical strategies for environmentally sustainable practices in gynecologic oncology.

The Role of Propofol-Based Total Intravenous Anesthesia and Regional Anesthesia in Cancer Surgery.

This case report presents the first documented use of a Bier block (intravenous regional anesthesia) for lower limb surgery in Pakistan, detailing its application in a 39-year-old male undergoing the removal of a dynamic compression plate from his left tibia. The procedure utilized a total of 50 mL of lignocaine, achieving effective analgesia throughout the surgery, with the patient reporting minimal discomfort. This case underscores the efficacy and safety of the Bier block as a viable alternative to general anesthesia for orthopedic procedures, addressing a significant gap in the literature regarding its use in lower limb surgeries. The successful outcome highlights the potential for improved postoperative pain management and sets a precedent for further research and clinical practice in this area. Abbreviations: IVRA: intravenous regional anesthesia, MET score: Metabolic Equivalent of Task score, PACU: Post-Anesthesia Care Unit, VAS: Visual Analog Scale Keywords: Lower Extremity; Orthopedic Procedures; Tourniquets; Compartment Syndromes; IVRA Citation: Ali L, Ali U, Qureshi AA, Nasir S, Fatima N. An uncommon approach of Bier block for tibial surgery; A case report. Anaesth. pain intensive care 2025;29(3):695-698. DOI: 10.35975/apic.v29i3.2780 Received: October 23, 2024; Revised: February 05, 2025; Accepted: March 23, 2025

The study focuses on the increasing incidence of distal radius fractures, particularly in individuals under 15 and over 50, and the critical need for effective perioperative pain management strategies. Distal radius fractures often require surgical intervention and pain control, essential to enhancing recovery and minimizing complications like chronic regional pain syndrome (CRPS). Standard analgesic options include hematoma blocks, Intravenous regional anesthesia (IVRA), regional nerve blocks, sedation, and general anesthesia. This research proposes a nerve block approach targeting the anterior interosseous nerve (AIN), posterior interosseous nerve (PIN), and superficial branch of the radial nerve (SBRN) following open reduction and internal fixation (ORIF) for distal radius fractures, as a potential strategy to improve pain relief and reduce CRPS risk. The study involves anatomical dissection of 15 cadaveric specimens to examine forearm nerve courses relevant to pain management in distal radius fractures. Landmarks were precisely mapped to optimize local anesthetic infiltration. Reference points were set 70 mm proximal to Lister's tubercle along the radial and ulnar edges of the radius, measuring nerve distances and anatomical positions. The SBRN had a mean fascial exit point 69.8 mm from Lister's tubercle and was located radially in 53.3% of cases and palmarly in 46.6%. The AIN was located 4.7 mm from the ulnar border and lay radial to the anterior interosseous artery in 80% of cases. The PIN was, on average, 6.7 mm from the ulnar border and ulnar to the artery in 63.6% of cases. This study identified anatomical landmarks to guide local anesthetic injections near the SBRN, PIN, and AIN to improve pain control after ORIF. LEVEL OF EVIDENCE: Level V: This study is based on anatomical preparations and expert recommendations, without clinical patient studies.

Background: Intravenous regional anesthesia (IVRA) is an efficient method of short limb surgery but often provides limited pain relief in the postoperative period. Dexmedetomidine is an α2-adrenergic agonist that can potentially improve local anesthetic effects, but there is limited evidence in Pakistan because of its previous unavailability. This study aimed to compare lidocaine alone and lidocaine combined with dexmedetomidine IVRA in below-elbow surgery. Methods: This randomized control study was conducted at Fatima Memorial Hospital, Lahore, from September 3, 2024, to March 2, 2025. 90 ASA I-II patients, aged 18-60 years, who were undergoing elective upper limb surgery, were randomly assigned to two groups. Group A received regional anesthesia with 40ml of lignocaine 0.5%, while Group B received (Bier's Block) the same lignocaine with 0.5µg/kg dexmedetomidine. Tourniquet pain after 2 hours and anesthesia duration were noted. Data were analyzed using SPSS v25.0 with a p-value ≤0.05 as statistically significant. Results: The Lidocaine plus Dexmedetomidine group showed significantly lower mean pain scores (1.49 ± 0.506) compared to the Lidocaine alone group (2.78 ± 0.704) with a p-value of 0.001. The duration of analgesia was significantly extended in the combination group (190.82 ± 33.71 minutes) when compared to the Lidocaine-alone group (145.73 ± 13.23 minutes), also with a p-value of 0.001. Conclusion: The combination of dexmedetomidine with lidocaine during IVRA is highly effective in enhancing postoperative analgesia and pain reduction that may lead to an efficient intervention to perform perioperative pain management during upper limb surgery.

Intravenous regional anesthesia (IVRA) is a widely used technique for hand and wrist surgeries. However, conventional upper arm IVRA requires higher anesthetic doses, which increases the risk of systemic toxicity. Forearm IVRA offers potential advantages, including lower anesthetic requirements and improved tourniquet tolerance. The study aims to compare the efficacy, analgesic effectiveness, and safety of forearm versus upper arm IVRA in elective hand and wrist surgeries. In this prospective, randomized, open-label clinical trial, 140 adult patients, classified as American Society of Anesthesiologists (ASA) physical status I - II and aged 21 - 65 years, scheduled for elective hand or wrist surgery at Ain Shams University Hospitals, were randomized into two equal groups: Upper arm IVRA and forearm IVRA. The outcomes measured included block success, onset of analgesia, tourniquet pain-free duration, pain scores, rescue analgesia requirements, and patient and surgeon satisfaction. Block success rates were similar between the forearm and upper arm IVRA groups (94.3% vs. 91.4%, P = 0.512). Forearm IVRA demonstrated a significantly longer tourniquet pain-free duration (45.7 ± 4.6 vs. 43.2 ± 4.7 minutes, P = 0.002) and a longer time to the first postoperative analgesic request (8.9 ± 0.9 vs. 5.8 ± 1.0 hours, P < 0.001), with lower 24-hour nalbuphine consumption (11.4 ± 4.2 vs. 28.7 ± 3.4 mg, P < 0.001). Patient satisfaction was higher in the forearm group (P < 0.001), while surgeon satisfaction did not differ significantly (P = 0.145). Forearm IVRA is an effective and safe alternative to upper arm IVRA for hand and wrist surgeries, offering superior tourniquet tolerance, prolonged analgesia, reduced opioid requirements, and higher patient satisfaction.

Acute pain management and the efficacy of analgesic therapies are essential in orthopedic surgery on the distal extremities of dogs' forelimbs. This is due to the manipulation of both soft and orthopedic tissues. Therefore, this study aimed to compare the antinociceptive, akinesia, cardiovascular, and plasma-level effects of adding atracurium to intravenous regional anesthesia (IVRA) with lidocaine in dogs. Fifty male Mongrel dogs weighing 15 ± 5kg and aged 2.5 ± 0.6 years were premedicated with 0.045mg/kg of atropine sulfate and 0.05mg/kg of acepromazine. While under general anaesthesia, the dogs were randomly allocated into two IVRA groups (n = 25/group): the lidocaine group (LG; 3mg/kg) and the atracurium (0.3mg/kg) combined with the lidocaine (3mg/kg) group (LAG). Following IVRA injections, the toe pinch response and nerve stimulation test were performed, with the contralateral limb serving as its control limb. The mean blood pressure (MAP), pulse rate (PR), respiratory rate (RR), end-tidal carbon dioxide level (EtCO2), rectal temperature, echocardiographic indices, and plasma lidocaine concentrations were measured. At 25, 35, 45, and 55min post-induction, the LAG exhibited a significantly lower (P ≤ 0.01) nociception limb withdrawal reflex score indicated by an absence of the limb withdrawal reflex (score 1) than the LG, which showed a mild limb trembling (score 2). Moreover, at 30, 40, 50, and 60min post-induction, the LAG had an absence of the carpus twitch (score 1) with a significantly deeper degree of nerve block (P ≤ 0.01) compared to the LG. There were no significant differences in the physiological parameters between groups during anesthesia time. Meanwhile, the MAP, PR, and RR were significantly higher (P ≤ 0.05) in the LG than in the LAG post-nociception stimuli and during the recovery period. After tourniquet removal, hypersalivation and muscle tremors were observed in four dogs in the LAG and one in the LG. The use of IVRA with atracurium/lidocaine is a potentially effective IVRA agent for enhancing analgesia and akinesia in the distal extremities of dogs. However, it is important to consider the potential signs compatible with systemic toxicity that may occur, such as hypersalivation and muscle tremors, after releasing the tourniquet.

To evaluate the efficacy of neuromuscular blocking agents (NMBAs) as adjuncts to intravenous regional anesthesia (IVRA). Two researchers independently searched PUBMED, EMBASE, the Cochrane Library databases, and CBM for randomized controlled trials assessing the efficacy of NMBAs as adjuvants in IVRA. This meta-analysis included 420 patients from 7 randomized controlled trials. Compared to IVRA using local anesthetics alone, the adjunctive use of NMBAs significantly shortened the onset time of sensory block [mean difference (MD) = -1.38 min, 95% CI: -2.02 to -0.75; P < 0.01] and motor block (MD = -2.39 min, 95% CI: -4.67 to -0.12; P = 0.04). Moreover, NMBAs prolonged the duration of motor block (MD = 6.97 min, 95% CI: 0.06 to 13.88; P = 0.05). However, no significant improvement was observed in the duration of pain relief (MD = 4.24 min, 95% CI: -1.43 to 9.91; P = 0.14). As adjuncts to IVRA, NMBAs significantly reduce the onset time of sensory and motor blocks compared to local anesthetics alone. Additionally, NMBAs prolong the duration of motor block. These agents enhance the efficacy of IVRA by optimizing neuromuscular blockade while maintaining anesthetic quality comparable to standard IVRA techniques.

Aim: This prospective, randomized, double-blind study compared the efficacy and safety of dexketoprofen trometamol (DT) and paracetamol in managing postoperative pain for patients undergoing intravenous regional anesthesia (IVRA) during hand surgery. Methods: Sixty-six ASA I-II patients aged 18-70 were enrolled after exclusion criteria, including drug allergies, psychiatric disorders, Raynaud’s disease, and anticoagulant therapy. Patients were randomized into two groups: Group 1 received 25 mg DT, and Group 2 received 500 mg paracetamol for postoperative pain relief. At home postoperatively, pain intensity was assessed using the visual analog scale (VAS), and rescue analgesia was provided if needed. Patients recorded pain relief efficacy, satisfaction levels, side effects, and tablet consumption over 30 hours. Results: While both DT and paracetamol provided adequate postoperative pain relief, key differences were observed. Group 1 reported significantly higher analgesic efficacy (p = 0.001) and satisfaction levels (p = 0.003), with 75.8% of patients experiencing complete pain relief compared to 42.4% in Group 2. Moreover, postoperative morphine requirements were significantly lower in Group 1 (p = 0.04), highlighting its superior ability to manage pain while minimizing opioid use. VAS scores at various postoperative intervals showed no statistically significant differences between the two groups. However, Group 1 reached peak pain intensity at 6 hours postoperatively, while Group 2 peaked at 12 hours, suggesting DT's faster onset of action. Both groups demonstrated similar demographic and surgical characteristics, ensuring robust comparability. The frequency of side effects, such as nausea, vomiting, headache, and insomnia, was low and comparable between the groups (p &amp;gt; 0.05), underscoring the safety profiles of both drugs. Conclusions: DT offers superior postoperative pain control, reduced opioid reliance, and higher patient satisfaction compared to paracetamol following IVRA in ambulatory hand surgery. These findings support DT as a promising alternative to paracetamol in multimodal analgesia strategies. Additional studies are needed to confirm these findings and examine the mechanisms behind the differences in observed outcomes. The choice of analgesic should remain patient-specific, considering individual clinical conditions, contraindications, and preferences.

Background: Neostigmine, a reversible acetylcholinesterase inhibitor (AChEI), has shown potential as an adjunct to local anesthetics like lidocaine in peripheral nerve blocks, including carpal tunnel syndrome (CTS). It may prolong analgesia by activating muscarinic receptors involved in pain modulation. Some studies report that adding neostigmine to lidocaine improves the duration of anesthesia and postoperative pain relief, particularly in upper limb procedures. However, results are mixed, possibly due to differences in doses or nerve barrier permeability. Overall, neostigmine’s role in enhancing analgesia in nerve blocks such as Bier's block and CTS remains an active area of investigation.Aim of study: This study aims to assess the analgesic efficacy of adding 0.5 mg neostigmine to 2% lidocaine in adult patients undergoing upper limb surgery under intravenous regional anesthesia (IVRA). Specifically, it evaluates the impact of this combination on intraoperative and postoperative pain, analgesic requirements, and recovery profiles, thereby contributing to improved perioperative pain management strategies.Patients and methods: A total of 52 patients admitted to Al-Fayhaa Teaching Hospital, Basrah, Iraq, were randomized into two groups of 26 patients each. One patient excluded from analysis from each group. In the control group, local anesthesia of 3 mg/kg lidocaine was administered with 40 mL of normal saline. While the neostigmine group patients received 3 mg/kg lidocaine with 0.5 mg neostigmine, the same amount of saline was administered. Physiological parameters, sensation, and motor activity onset time, and recovery time after intravenous regional anesthesia were registered.Results: The neostigmine group included males (4%) and females (96%) with a mean age of 41.76±5.69 years, while the control group included males (20%) and females (80%) with a mean age of 37.6±5.00 years. There were no differences in the demographic data (American Society of Anesthesiologists (ASA), gender, weight), in addition to pinprick onset and recovery times, touch onset time, and block recovery time between both groups. A significant difference was observed in the age, surgical duration time, tourniquet time, touch recovery time, and motor block onset time between both groups (p < 0.05). In addition, no significant differences in postoperative complications were observed between the two groups (p = 0.074). However, there was a significant association in analgesic need, whether intraoperative or to reduce tourniquet pain, among the compared groups (p < 0.001).Conclusion: The addition of neostigmine to lidocaine in the surgical treatment of CTS shows no significant benefits regarding postoperative pain relief, but it is of benefit during the operation.

Background: Obstructive sleep apnea (OSA) is a frequent comorbidity in patients undergoing ENT surgery, significantly increasing the risk of perioperative complications such as hypoxia, airway obstruction, and cardiovascular instability. Effective anesthesia management is critical to reducing these risks and improving postoperative recovery. Anesthesia type may directly influence respiratory outcomes, pain control, and hospital stay in this vulnerable population. Objective: To evaluate and compare the impact of total intravenous anesthesia (TIVA), inhalational anesthesia, and regional anesthesia on perioperative outcomes in patients with sleep apnea undergoing ENT surgery. Methods: A prospective, observational study was conducted involving 100 patients diagnosed with OSA and scheduled for ENT surgical procedures. Participants were stratified into three anesthesia technique groups: TIVA (n=33), inhalational (n=34), and regional anesthesia (n=33). Perioperative outcomes assessed included the incidence of postoperative respiratory complications, postoperative pain scores (using a standardized 10-point pain scale), and hospital length of stay. Statistical analysis was performed using SPSS v27, and significance was set at p&lt;0.05. Results: Postoperative respiratory complications occurred in 10% of patients in the TIVA group, 25% in the inhalational group, and 30% in the regional group (p=0.01). The average hospital stay was shortest in the TIVA group at 2.5 days, compared to 3.5 days for inhalational and 4.5 days for regional anesthesia (p=0.02). The regional anesthesia group reported the lowest postoperative pain scores (3/10), followed by TIVA (5/10) and inhalational (6/10) groups (p=0.03). Conclusion: TIVA appears to offer advantages in reducing postoperative respiratory complications and shortening hospital stay in OSA patients undergoing ENT surgery, while regional anesthesia provides superior pain control. Personalized anesthesia selection based on patient-specific needs may significantly enhance surgical outcomes.

Background: This study aimed to determine the effect of adding low doses of dexmedetomidine as an adjuvant to lidocaine in regional intravenous anesthesia in patients receiving surgery. Methods: In the present clinical trial, 120 patients' candidates for upper extremity orthopedic surgery with regional venous anesthesia in 4 groups of 30 people distributed in groups respectively 0.6, 0.5 and 0.4 micrograms/kg of dexmedetomidine plus 0.5 lidocaine were injected and in the fourth group, an equal volume of normal saline was administrated. Patients were examined and compared before drug injection and 1, 5, 10, 15, 30, 45 and 60 minutes after drug injection in terms of time of onset and recovery of sensory and motor block, hemodynamic parameters, postoperative pain intensity and analgesic consumption. Results: The average pain intensity during the research in the four dexmedetomidine groups was 0.6, 0.5, 0.4 and the control group, respectively, 2.12 ± 1.33, 2.82 ± 0.76, 2.26 ± 2.3, and 4.4 ± 1.5, and the difference between the groups was significant (&gt;0.001). P). In the two-by-two analysis of the groups, the average pain intensity was significant between the two groups: dexmedetomidine 0.6 and control (P&lt;0.001), dexmedetomidine 0.5 and control (P=0.003), and dexmedetomidine 0.4 and control (P&lt;0.001). Conclusion: Using a dose of 0.6 micrograms/kg of dexmethomidine along with lidocaine leads to a decrease in the severity of the postoperative period, a decrease in the need for painkillers, and also an increase in the time of postoperative pain relief in patients.

BackgroundThis study aimed to compare the efficacy and safety of two anesthetic techniques in patients undergoing carpal tunnel release surgery: intravenous regional anesthesia (IVRA) and the wide-awake local anesthesia no tourniquet (WALANT) technique.Materials and MethodsA retrospective observational dual-center study was conducted, including 102 patients diagnosed with moderate-to-severe carpal tunnel syndrome (CTS) unresponsive to conservative treatment. Outcomes were assessed using the visual analog scale (VAS) for pain and the Duruoz Hand Index (DHI) for hand functionality. Comparisons were made based on age, gender, preoperative VAS scores, incision length, and surgical procedure duration.ResultsThe outcomes of the WALANT (n = 51) and IVRA (n = 51) techniques in CTS surgery were compared. The IVRA group had a shorter operation time (2.49 ± 0.50 minutes) and faster return to daily activities (10.13 ± 9.50 days) compared with the WALANT group (operation time: 7.27 ± 1.35 minute, return to daily activities: 17.64 ± 2.52 days) (p < 0.05). Additionally, postoperative analgesic requirements were significantly lower in the IVRA group (8/51; 15.6%) than in the WALANT group (37/51; 72.5%) (p < 0.05). Both groups showed significant postoperative improvements in VAS and DHI scores (p < 0.05), with the IVRA group demonstrating a greater improvement in DHI scores (14.76 ± 0.43) compared with the WALANT group (12.76 ± 0.45) (p < 0.05).ConclusionIVRA with small incisions demonstrated superior outcomes in CTS surgery compared with WALANT, including shorter operation times, faster recovery, and reduced postoperative analgesic requirements. These findings suggest that IVRA may be a more favorable option for both patients and surgeons in carpal tunnel release surgery.

Background: Bier’s block is a reliable, straightforward, and safe technique for anesthetizing upper limb. This study aimed to compare between the effectivity of IV Lidocaine (0.5%) and IV Prilocaine (0.5%) in Bier’s block in terms of onset and recovery time of sensory and motor block, tourniquet tolerance, vital signs during and after surgery, and the need for intraoperative analgesia. Subjects and Methods: This study was conducted at Erbil Teaching Hospital and Emergency Hospital, from the period of May 2021 to October 2021. In this prospective, randomized, double-blind study, two groups of 25 patients were prepared for hand operation. Patients in group A were given IV Lidocaine (0.5%) while patients in group B were given IV Prilocaine (0.5%). Sensory and motor block and their recovery times, tourniquet pain, intra-operative analgesic needs, vital signs, and visual analog scale (VAS) scores were recorded. Results: No significant difference was found in the onset of sensory and motor block in both Lidocaine (5.5±1.6 min) and Prilocaine (5.9±1.6 min) groups (p-value=0.319), while the recovery of sensory block after releasing tourniquet was significantly shorter in Prilocaine group (7.4±1.4 min vs. 5.4±0.8 min) (p-value=0.003). The VAS score of Prilocaine group during and after surgery was significantly higher, with more patients receiving analgesia (5 vs. 2). Conclusions: Both IV Lidocaine (0.5%) and IV Prilocaine (0.5%) appeared to be effective local anesthetics in Bier’s block of distal upper extremity, intraoperatively and postoperatively. IV Lidocaine (0.5%) provided greater analgesia, while IV Prilocaine (0.5%) exhibited quicker sensory block recovery after tourniquet cuff release.

Lameness is an important cause of economic loss in the beef in­dustry due to reproductive inefficiency, weight loss and recum­bency leading to increased risk of the affected animal dying or being culled. Lameness must be viewed as an important bovine welfare issue as well. Most lameness in cattle is hoof-based. To do a thorough hoof examination, good hoof restraint is neces­sary. In many cases where invasive procedures are necessary, regional limb anesthesia (RLA) using lidocaine in the dorsal digital vein (Bier Block) is beneficial. Post-op analgesia using an NSAID such as meloxicam is both important and beneficial. RLA allows one to perform invasive procedures necessary for treatment of septic joints and subsolar abscesses. Treatment of a septic P2-P3 joint involves antibiotics and might involve am­putation, facilitated ankylosis via joint lavage/abscess drainage or facilitated ankylosis via drilling through P2-P3 to provide abscess drainage. All these procedures can work. The environ­ment the cow lives in will be important in deciding the best method to resolve the septic joint. It is important to communi­cate to the client that any treatment of septic arthritis of P2-P3 will be expensive and will require several treatment sessions and owner-delivered aftercare. It will take one to two months before ankylosis has occurred.

Surgical procedures involving the tarsal joint are common in cattle. Indications for tarsal surgery include joint lavage, arthrotomy, the treatment of injuries, and hygromas. The goal of the present study was to lay the foundation for a reliable method of nerve block desensitisation of the bovine tarsus. Two nerve block techniques were simulated in an anatomical cadaver study on six bovine pelvic limbs for each technique. In the first technique, injection sites were based on palpation of anatomical structures, and in the second technique, ultrasound guidance was used to localise the nerves. After injection of dye (methylene blue) solution using anatomical landmark-based or ultrasound guidance methods, the 12 cadaver limbs were dissected, and the effectiveness of sham anaesthesia was determined based on the proximity of the dye solution to the nerve and the length of its distribution along the nerve. The ultrasound-guided local anaesthesia required significantly more time to perform compared with nerve blocks based on anatomical landmarks. However, the dye reached the target area in 25 of 30 application sites using ultrasound-guided local anaesthesia compared with 13 of 30 sites using the anatomical landmark-based technique. Ultrasonographic guidance led to fewer inadvertent intravascular and intramuscular injections. In conclusion, the ultrasound-guided local anaesthesia is a promising alternative to general anaesthesia, epidural, and intravenous regional anaesthesia for surgical procedures of the bovine tarsal joint and eliminates the disadvantages of other anaesthetic techniques, like general anaesthesia and intravenous regional anaesthesia. The practicability and utility of this technique still require validation invivo.

Efficacy and Safety of Adding Ketamine to Lidocaine in Intravenous Regional Anesthesia: A Meta-analysis of Randomized Controlled Trials