Intravenous regional

Intravenous regional anesthesia—injection of local anesthetic into a suitable vein supplying the limb to be anesthetized the blood flow from this limb is then restricted by a tourniquet... 

Local anaesthetics can be applied topically, deposited around peripheral nerves, or infiltrated into tissues. Central neural blockade can be produced by injection into the subarachnoid or epidural spaces. Less common uses are for intravenous regional anaesthesia and attenuation of cardiovascular responses to tracheal intubation. The membrane-stabilising effect of local anaesthetics has been utilised in the treatment of myocardial arrhythmias. 

Lidocaine is used for all forms of infiltration anaesthesia, in addition to peripheral, regional, spinal and epidural block. Unlike bupivacaine, it is suitable for use in intravenous regional anaesthesia. Duration of anaesthesia is about 1 hour but this can be prolonged to 2 hours by the addition of adrenaline. The maximum doses are shown in Table 5.2. 

Prilocaine is suitable for most types of local anaesthetic block but is not suitable for epidural use in obstetrics because of the need for repeat administration. Its main uses are for infiltration anaesthesia and intravenous regional anaesthesia where its low toxicity makes it the drug of choice. Levobupivacaine... 

With local infiltration, toxic side-effects like convulsions and cardiovascular collaps occur in the dose range of 2.5 to 3 mg/kg body weight. Because of its systemic toxicity, bupivacaine is contraindicated for intravenous regional anesthesia. 

The most common side-effect of levobupivacaine is hypotension. Therefore, levobupivacaine is contraindicated for in intravenous regional block and patients with severe hypotension. 

Chloroprocaine Nesacaine Rapid Short Infiltration Peripheral nerve block Epidural Intravenous regional block... 

Karalezli N, Karalezli K, Iltar S, et al. Results of intravenous regional anaesthesia with distal forearm application. Acta Orthop Belg. 2004 70 401-405. 

Lake AP. Intravenous regional sympathetic block past, present and future Pain Res Manag. 2004 9 35-37. 

In a randomized, double-blind study, 14 patients who underwent elective surgery for correction of bilateral arthritic deformities of the feet received 15 ml of 0.9% saline containing diamorphine 2.5 mg into the cannula in one foot and 15 ml of saline into the other foot (6). Intravenous regional diamorphine did not improve postoperative pain relief or secondary hyperalgesia. There were no significant adverse effects. 

Intravenous. A double cuff is applied to the arm, inflated above arterial pressure after elevating the limb to drain the venous system, and the veins filled with local anaesthetic, e.g. 0.5-1% lidocaine without adrenaline (epinephrine). The arm is anaesthetised in 6-8 min, and the effect lasts for up to 40 min if the cuff remains inflated. The cuff must not be deflated for at least 20 minutes. The technique is useful in providing anaesthesia for the treatment of injuries speedily and conveniently, and many patients can leave hospital soon after the procedure. The technique must be meticulously conducted, for if the full dose of local anaesthetic is accidentally suddenly released into the general circulation severe toxicity and even cardiac arrest may result. Bupivacaine is no longer used for intravenous regional anaesthesia as cardiac arrest caused by it is particularly resistant to treatment. Patients should be fasted and someone skilled in resuscitation must be present. 

Prilocaine is used similarly to lidocaine (t,i 1.5 h), but it is slightly less toxic. It used to be the preferred drug for intravenous regional anaesthesia but it is... 

Pitkanen MT, Rosenberg PH, Pere PJ, Tuominen MK, Seppala TA. Fentanyl-prilocaine mixture for intravenous regional anaesthesia in patients undergoing surgery. Anaesthesia 1992 47(5) 395-8. 

Brachial plexus anesthesia Buccal anesthesia Caudal anesthesia Cervical plexus anesthesia Dental anesthesia Digital anesthesia Epidural anesthesia Intercostal nerve anesthesia Interpleural anesthesia Intra-articular anesthesia Intradermal anesthesia Intrathecal (spinal) anesthesia Intravenous regional anesthesia Laryngeal anesthesia Lumbar plexus anesthesia Nasal anesthesia Neck anesthesia Obstetric anesthesia Ocular anesthesia Oropharyngeal anesthesia Otic anesthesia Paravertebral anesthesia Perianal anesthesia Peritonsillar anesthesia Respiratory anesthesia Sciatic nerve anesthesia Stellate ganglion anesthesia... 

Systemic toxic reactions are the most common complications of intravenous regional anesthesia, and they occur soon after the tourniquet is released. In cases of early accidental tourniquet release or rupture, deaths have resulted prilocaine seems to be the safest agent for this technique (271). 

A study of hdocaine toxicity in intravenous regional anesthesia showed that two of 24 patients who were given 0.5% lidocaine 40 ml for carpal tunnel decompression had serum hdocaine concentrations above the target range 2 minutes before and 2, 5, and 10 minutes after distal tourniquet deflation (274). However, no patients had signs of central nervous system or cardiovascular toxicity. 

Chloroprocaine, because of its rapid onset and ester hydrolysis, should be the ideal agent for intravenous regional anesthesia. However, there are reports that it can cause endothelial damage and dysrhythmias after tourniquet deflation (275). 

Phlebitis seems to have been triggered by intravenous regional anesthesia in a 32-year-old smoker who was also taking oral contraceptives (276). 

When 20 patients each received 40 ml of 0.5 % chloropro-caine or 0.5 % lidocaine for intravenous regional anesthesia, chloroprocaine caused a significantly higher incidence of a metallic taste (22 versus 0%) than hdocaine when the study was repeated using alkahnized instead of plain chloroprocaine, there was no significant difference between the groups (280). 

Coleman M, Kelly DJ. Local anaesthetic toxicity in a pregnant patient undergoing lignocaine-induced intravenous regional anaesthesia. Acta Anaesthesiol Scand 1998 42(2) 267-9. 

Abdulla W, Kroll S, Eckhardt-Abdulla R. Intravenous regional anaesthesia—a new approach in clinical application. Anasthesiol Intensivmed 2000 41 94-103. 

Kireker HD, Aynacioglu AS, Goksu S. Determination of 0.5% lidocaine serum concentrations and evaluation for toxicity in intravenous regional anaesthesia. Turk Anesteziyol Reanim 2000 28 211-16. 

Lang SA. Intravenous regional anesthesia. Anesth Analg 1998 86(6) 1334-5. 

Chan VW, Weisbrod MJ, Kaszas Z, Dragomir C. Comparison of ropivacaine and lidocaine for intravenous regional anesthesia in volunteers a preliminary study on... 

Cherng CH, Wong CS, Ho ST. Acute aphesia following tourniquet release in intravenous regional anesthesia with 0.75% lidocaine. Reg Anesth Pain Med 2000 25(2) 211-12. 

Hartmannsgruber MW, Halaszynski TM. Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery. Anesthesiology 2001 95(3) 627-31. 

Lavin PA, Henderson CL, Vaghadia H. Non-alkalinized and alkalinized 2-chloroprocaine vs lidocaine for intravenous regional anesthesia during outpatient hand surgery. Can J Anaesth 1999 46(10) 939-45. 

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