Intravenous Regional Anesthesia Research Articles

Addition of Midazolam to Lidocaine for Intravenous Regional Anesthesia

Addition of Midazolam to Lidocaine for Intravenous Regional Anesthesia

Adding Magnesium Sulfate to Lidocaine for Intravenous Regional Anesthesia

Adding Magnesium Sulfate to Lidocaine for Intravenous Regional Anesthesia

395: Dexmedetomidine or Lornoxicam Added to Prilocaine for Intravenous Regional Anesthesia: A Randomized Controlled Study

395: Dexmedetomidine or Lornoxicam Added to Prilocaine for Intravenous Regional Anesthesia: A Randomized Controlled Study

597. Addition of Midazolam to Lidocaine for Intravenous Regional Anesthesia

597. Addition of Midazolam to Lidocaine for Intravenous Regional Anesthesia

395. Dexmedetomidine or Lornoxicam Added to Prilocaine for Intravenous Regional Anesthesia: A Randomized Controlled Study

395. Dexmedetomidine or Lornoxicam Added to Prilocaine for Intravenous Regional Anesthesia: A Randomized Controlled Study

Dexmedetomidine or Lornoxicam Added to Prilocaine for Intravenous Regional Anesthesia: A Randomized Controlled Study

Dexmedetomidine or Lornoxicam Added to Prilocaine for Intravenous Regional Anesthesia: A Randomized Controlled Study

379. Addition of Dexmedetomidine or Neostigmine to Lidocaine for Intravenous Regional Anaesthesia

379. Addition of Dexmedetomidine or Neostigmine to Lidocaine for Intravenous Regional Anaesthesia

Intravenous Regional Anesthesia Administered by the Operating Plastic Surgeon: Is It Safe and Efficient? Experience of a Medical Center

Background: Intravenous regional anesthesia (Bier's block) is an effective method of providing anesthesia for extremity surgery. This technique is most suitable for short-duration, less than 60-minute surgical procedures in distal extremities. Earlier studies recommended that intravenous regional anesthesia be performed by anesthesiologists who are familiar with the technique and fully trained to treat its complications. This study was conducted to demonstrate that intravenous regional anesthesia administered by the operating plastic surgeon is safe, efficient, and simple to perform. Methods: A 5-year retrospective chart review (January of 2000 to December of 2004) was undertaken. The study included patients who underwent surgical procedures and were administered intravenous regional anesthesia by the surgeon. Results: Four hundred forty-eight patients were included in the study, and 479 operations of 483 scheduled were completed under intravenous regional anesthesia performed by the operating surgeon. Intravenous regional anesthesia was efficient in 478 of 479 of the cases (99.8 percent). Tourniquet-related technical problems were noted in five of 483 cases (1 percent), resulting in cancellation of four operations, with no reported consequent anesthetic toxicity. Minor complications were reported in six of 479 of the cases (1.2. percent). No major complications occurred. Conclusions: Despite earlier worries about the safety of intravenous regional anesthesia if not administered by anesthesiologists, the authors found that intravenous regional anesthesia represents a safe and efficient technique of anesthesia for extremity surgery when performed carefully and appropriately by the operating surgeon. The authors suggest that plastic surgeons familiarize themselves with this technique, which is simple to perform. This could probably result in lower overall costs and greater autonomy for the surgeon.

Intravenous Regional Anesthesia Administered by the Operating Plastic Surgeon: Is It Safe and Efficient? Experience of a Medical Center

Intravenous Regional Anesthesia Administered by the Operating Plastic Surgeon: Is It Safe and Efficient? Experience of a Medical Center

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.

Treatment of Pachonychia congenita and Epidermolysis bullosa simplex with plantar injections of botulinum toxin

Pachonychia congenita (PC) and Epidermolysis bullosa simplex (EBS) are rare genodermatosis, which may be associated with painful, focal hyperkeratosis on the soles. Plantar sweating at high ambient temperatures increases the blistering of the callosities. Here we report 13 patients with PC (8) and EBS (5) who had great problems in walking, especially during summer time. They were treated with intracutaneous plantar injections of botulinum toxin type A (Dysport ® , Ipsen, Slough, UK, 100 U/ml) or type B (Neurobloc ® , Solstice Neurosciences Inc., 250 U/ml) after prior intravenous regional anaesthesia of the foot with a low tourniquet and 25 ml prilocaine (5 mg/ml) or general anesthesia. Within 1–2 weeks all 8 PC patients and 4 out of 5 EBS patients experienced dryness and a remarkable relief of pain from plantar pressure sites. The effect duration was 6 weeks to 12 months. Repeated injections over a period of 5 years confirmed the good results with no side effects or tachyphylaxis noted.

Comparison of two different methods of limb exsanguination (Esmarch bandage and limb elevation) in intravenous regional anesthesia

Study Objective To compare the effect of the Esmarch bandage and limb elevation techniques in quality of painlessness of intravenous (IV) regional anesthesia. Design Double-blinded, controlled, randomized clinical trial. Setting Operating room of university hospital. Patients 70 ASA physical status І and П patients who were scheduled for repair of upper extremity soft-tissue injuries. Interventions Patients were randomized for exsanguination of their upper extremities either by Esmarch bandage (Esmarch group) or by limb elevation (elevation group) to 90° for about 5 minutes. Measurements Preoperative and intraoperative pain intensities were evaluated by verbal response scale. The intensity of pain and need for IV sedative and analgesic medications were compared in both groups by Fisher's exact and χ 2 tests. Main Results There was no significant statistical difference between the pain intensity data of two groups either before or after starting the surgery. The need for IV supplemental drugs for pain relief was similar in both groups. Conclusion The limb elevation technique, while producing less discomfort for patients, can be as effective as the Esmarch bandage in limb exsanguination during IV regional anesthesia.

Cyclooxygenase inhibition attenuates sympathetic responses to muscle stretch in humans

Passive muscle stretch performed during a period of post-exercise muscle ischemia (PEMI) increases muscle sympathetic nerve activity (MSNA), and this suggests that the muscle metabolites may sensitize mechanoreceptors in healthy humans. However, the responsible substance(s) has not been studied thoroughly in humans. Human and animal studies suggest that cyclooxygenase products sensitize muscle mechanoreceptors. Thus we hypothesized that local cyclooxygenase inhibition in exercising muscles could attenuate MSNA responses to passive muscle stretch during PEMI. Blood pressure (Finapres), heart rate, and MSNA (microneurography) responses to passive muscle stretch were assessed in 13 young healthy subjects during PEMI before and after cyclooxygenase inhibition, which was accomplished by a local infusion of 6 mg ketorolac tromethamine in saline via Bier block. In the second experiment, the same amount of saline was infused via the Bier block. Ketorolac Bier block decreased prostaglandin synthesis to approximately 34% of the baseline. Before ketorolac Bier block, passive muscle stretch evoked significant increases in MSNA (P < 0.005) and mean arterial blood pressure (P < 0.02). After ketorolac Bier block, passive muscle stretch did not evoke significant responses in MSNA (P = 0.11) or mean arterial blood pressure (P = 0.83). Saline Bier block had no effect on the MSNA or blood pressure response to ischemic stretch. These observations indicate that cyclooxygenase inhibition attenuates MSNA responses seen during PEMI and suggest that cyclooxygenase products sensitize the muscle mechanoreceptors.

Progress in clinical .researches on chloroprocaine

Chloroprocaine,an ester local anesthetic agent,derives from procaine by joining chlorine substitution to the aromatic ring,with characteristics of rapid onset and short-action.This article reviewed the clinical researches of chloroprocaine on epidural and spinal block,local infiltration,peripheral and central nerve block,and intravenous regional anesthesia etc. Key words: chloroprocaine; aneshtesia

The Analgesic Effect of Intravenous Neostigmine and Transdermal Nitroglycerine Added to Lidocaine on Intravenous Regional Anesthesia (Bier`s Block): A Randomized, Controlled Study in Hand Surgery

The Analgesic Effect of Intravenous Neostigmine and Transdermal Nitroglycerine Added to Lidocaine on Intravenous Regional Anesthesia (Bier`s Block): A Randomized, Controlled Study in Hand Surgery

Regional anaesthesia techniques for orthopaedic surgery

Background : In recent years, there has been a significant resurgence of interest in regional anaesthesia techniques. Despite various advantages, regional anaesthesia is not used to its full potential in orthopaedic surgeries. Methods : This study was conducted to evaluate the efficacy and safety of regional anaesthesia techniques in 400 consecutive patients, posted for orthopaedic surgeries in a tertiary care centre. Data was analysed for patient profile, type of surgery, nature of anaesthetic technique used, success rate, complications and satisfaction level of patients. Result : Age of patients ranged from three months to 92 years with male preponderance (84.5 %). Regional anaesthesia was used in 85% cases. Most frequently used technique for upper limbs was supraclavicular brachial plexus block (12.05 %) followed by interscalene block (5.58 %) and intravenous regional anaesthesia or Bier's block (2.64 %). For lower limbs, subarachnoid block was used in 50 % cases followed by combined spinal-epidural technique (21.47 %) and paravertebral block (4.70 %). Less commonly used techniques like lumbar plexus block, popliteal fossa block, sciatic + femoral nerve blocks were found to be useful but incidence of partial blocks was high. Overall success rate was 96.17 %. In 22.05 % cases supplementation with analgesic / sedative was needed, whereas in 3.82 % cases, technique was converted into general anaesthesia. There was no major complication. Six patients had reversible sensory neuropathy. In 91.64 % cases, satisfaction level was good to excellent. Conclusion : Skilfully performed techniques in regional anaesthesia can facilitate excellent surgical anaesthesia and postoperative pain management.

BIER’S BLOCK

. Objective: To compare the duration of anaesthesia and degree of analgesia during intravenousregional anaesthesia using lignocaine alone and lignocaine with ketorolac. Design: This international quasiexperimental study Setting: Nishtar Hospital, Multan. Period: Six months (from June 2004 to November 2004).Material and Methods: Patients with known allergy to local anaesthesia or keteroloca and with hepatic, renal diseasewere not included in the study. Results: Mean pain score at 0,1,2,3,4,5,6 in both groups after release of tourniquet.The quality of analgesia observed in both groups showed that 20 patients in lignocaine + ketorolac group had excellentanalgesia compared with only 4 patients in lignocaine group. Tourniquet pain was not experienced in any patient inboth groups; owing most probably to the inflation of distal tourniquet cuff on the anaesthetized part of the arm withrelease of proximal tourniquet, 10 minutes after injection of solution. Conclusion: It is concluded that 30 mg ketorolacadded to lignocaine in IVRA increases degree of anaesthesia and also provides prolonged postoperative analgesia.

Local prostaglandin blockade attenuates muscle mechanoreflex-mediated renal vasoconstriction during muscle stretch in humans

During exercise, muscle mechanoreflex-mediated sympathoexcitation evokes renal vasoconstriction. Animal studies suggest that prostaglandins generated within the contracting muscle sensitize muscle mechanoreflexes. Thus we hypothesized that local prostaglandin blockade would attenuate renal vasoconstriction during ischemic muscle stretch. Eleven healthy subjects performed static handgrip before and after local prostaglandin blockade (6 mg ketorolac tromethamine infused into the exercising forearm) via Bier block. Renal blood flow velocity (RBV; Duplex Ultrasound), mean arterial pressure (MAP; Finapres), and heart rate (HR; ECG) were obtained during handgrip, post-handgrip muscle ischemia (PHGMI) followed by PHGMI with passive forearm muscle stretch (PHGMI + stretch). Renal vascular resistance (RVR, calculated as MAP/RBV) was increased from baseline during all paradigms except during PHGMI + stretch after the ketorolac Bier block trial where RVR did not change from baseline. Before Bier block, RVR rose more during PHGMI + stretch than during PHGMI alone (P < .01). Similar results were found after a saline Bier block trial (Delta53 +/- 13% vs. Delta35 +/- 10%; P < 0.01). However, after ketorolac Bier block, RVR was not greater during PHGMI + stretch than during PHGMI alone [Delta39 +/- 8% vs. Delta40 +/- 12%; P = not significant (NS)]. HR and MAP responses were similar during PHGMI and PHGMI + stretch (P = NS). Passive muscle stretch during ischemia augments renal vasoconstriction, suggesting that ischemia sensitizes mechanically sensitive afferents. Inhibition of prostaglandin synthesis eliminates this mechanoreceptor sensitization-mediated constrictor responses. Thus mechanoreceptor sensitization in humans is linked to the production of prostaglandins.

Biofeedback in Pain Management: Bier Blocks for Complex Regional Pain Syndrome

This feature presents information for patients in a question and answer format. It is written to simulate actual questions that many pain patients ask and to provide answers in a context and language that most pain patients will comprehend. Issues addressed in this issue are the role of the biofeedback in pain management and Bier blocks for complex regional pain syndrome.