Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

Abstract

m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) 2 4 7 -2 5Methods: An observational case series was designed with the hypothesis that a combination of HB and IVRA would overcome the aforementioned drawbacks. A standardized protocol was followed for HB with 0.1 ml/kg of 0.5% bupivacaine preceding the conduct of IVRA, which permitted adequate exsanguination of the extremity (using compression bandage). For IVRA, 0.5% lignocaine at 3 mg/kg was used with an electro-pneumatic tourniquet. Pain scores were noted after the HB, at exsanguination and during surgery.Results: 100 cases were studied. Average time of onset of block after HB was 2 min 18 s. By the time the IVRA procedure was performed, 99% of patients had a pain score of zero. The quality of surgical anaesthesia revealed that 94% of the patients did not have any pain of incision, tourniquet or positioning at any time during surgery. Conclusion:The use of dual technique of HB and IVRA improved patient acceptance and compliance, and the safety and efficacy of the IVRA. The combination anaesthesia was found to be easy to administer, effective and safe with no complications. #

Peripheral nerve blocks for closed reduction of distal radius fractures—A protocol for a systematic review

“…Several methods of anaesthesia are proposed for closed reduction, among them is, intravenous regional anaesthesia (IVRA)—currently recommended by The National Institute for Health and Care Excellence guidelines 8,9 . Studies have shown that the anaesthesia method influences pain perception and muscle relaxation during closed reduction, consequently affecting the quality of reduction and a number of attempts 10–12 . Current methods of anaesthesia used for closed reduction of DRFs may be insufficient regarding pain relief and muscle relaxation, potentially compromising the reduction quality and patient satisfaction 13 .…”

“…8,9 Studies have shown that the anaesthesia method influences pain perception and muscle relaxation during closed reduction, consequently affecting the quality of reduction and a number of attempts. [10][11][12] Current methods of anaesthesia used for closed reduction of DRFs may be insufficient regarding pain relief and muscle relaxation, potentially compromising the reduction quality and patient satisfaction. 13 Peripheral nerve blocks (PNBs) can provide complete afferent and efferent blockade, are well-established for upper extremity surgery and have a good safety profile.…”

Nitroglycerin as Adjuvant to Two Different Doses of Lidocaine During IVRA for Hand Surgery

“…Most surgeries at the wrist and forearm are performed using a tourniquet to minimize blood loss [1] and are carried upon under general anesthesia [2], local infiltration [3], brachial plexus blocks [2] or intravenous regional anesthesia (IVRA) [4]. IVRA is an effective method of providing anesthesia for extremity surgery, with published success rates ranging from 94% to 98% [5]. Despite of the settled efficacy of IVRA, it may be associated with serious complications related to local anesthetic (LA) toxicity that may be occurred secondary to LA leak [6], accidental tourniquet release or rapid tourniquet deflation [7].…”

Does the Use of Nitroglycerin Patch Improve Local Anaesthetic Effects in Bier’s Block? A Double-Blind Placebo Controlled Study

“…Intravenous regional anaesthesia (IVRA) which was firstly described by August Bier in 1902 [2] is used successfully as a sole technique for upper limb surgeries [3]. It is a reliable, simple, cost-effective, and widely accepted technique of regional anaesthesia [1].…”