Intravenous Regional Anesthesia: The Old and Recent Techniques? Review Article

Abstract

Background: A straightforward and efficient anesthetic approach for hand and forearm surgery is intravenous regional anesthesia (IVRA), often known as the Bier Block. Dr. August Bier developed this method in 1908, and it offers total anesthesia as well as a bloodless operating room. Historically, the local anesthetic has been contained and a bloodless surgical field has been created by using an upper arm tourniquet. Major issues following IVRA with an upper arm tourniquet are uncommon, although they typically arise from systemic toxicity of local anesthetics upon tourniquet relaxation. Convulsions, coma, respiratory depression and arrest, and cardiovascular depression are signs of significant systemic local anesthetic responses, which might be lethal. Because of this, some medical professionals favor general anesthesia or other loco-regional procedures for hand and forearm surgery. Objective: The aim of this review was to compare the effects of early vs late distal tourniquet deflation during hand and forearm surgery under intravenous regional anesthetic with or without ketorolac. Methods: A comprehensive search was conducted in PubMed, Google Scholar, and Science Direct, from August 2000 to July 2021, using the keywords "Deflation, Distal tourniquet, Intravenous Regional Anesthesia, Ketorolac, Hand and Forearm Surgery". The reviewers evaluated relevant literature references as well. Only the most recent or complete study was taken into account. Examples of articles that weren't regarded as significant scientific research include unpublished manuscripts, oral presentations, conference abstracts, and dissertations. The lack of resources for translation has led to the ignoring of documents written in languages other than English. Results: The reviewed literature showed that alternative adjustments in extremities surgery can improve IVRA. In shortterm hand procedures, the forearm tourniquet may be chosen since it is simple to administer, has a minimal risk of toxicity, and offers an early block to healing. Conclusion: Depending on the patient's preferences, a Bier block with a forearm tourniquet can be utilized with or without further sedation or analgesics.

Efficacy of Hematoma Block VS Conscious Sedation in Terms of Pain Relief for Manipulation and Reduction of Distal Radius Fracture

“…1 However, it brings along with it complications like, tourniquet site pain, local anesthetic toxicity, and immediate surgical site pain ensuing tourniquet deflation and risk of anesthetic leakage due to accidental tourniquet deflation. 9 For DRF reduction, PSA an alternative effective method of analgesia. 10 PSA is widely used in the ED as a part of daily practice in tertiary care hospitals, but these patients are under the risk of respiratory depression and need close monitoring.…”