Intravenous Regional Anesthesia Using a Forearm Tourniquet: A Safe and Effective Technique for Outpatient Hand Procedures

Abstract

Background: Bier block provides anesthesia of an entire extremity distal to the tourniquet without necessitating direct injection at the surgical site. This avoids obscuring anatomy with local anesthetic and anesthetizes a wide area, allowing for multiple procedures and incisions. We hypothesize that a low-volume Bier block with forearm tourniquet, rather than a traditional brachial tourniquet, is a safe, well-tolerated, and effective anesthesia technique. Methods: All cases in which adult patients underwent hand procedures using Bier block anesthesia by a single surgeon over a 4-year period were reviewed. Data collected included patient demographics, procedure(s) performed, complications, tourniquet time and settings, procedure and in-room time, and supplemental medications administered. Results: In all, 319 patients were included, 103 from a university hospital and 216 from an ambulatory surgery center. The most commonly performed procedures were carpal tunnel release (205 cases) and trigger digit release (83 cases). Most patients received a 125-mg dose of lidocaine for the Bier block; many also received additional sedatives. Twenty-three patients received no additional medications. No patients required conversion to general anesthesia. One complication (0.3%) occurred, with paresthesias and tinnitus that resolved without intervention. The average tourniquet time was 24 minutes (SD = 4.3 minutes). Patients were discharged at a median of 49 minutes postoperatively, and 9.1% of patients received supplemental analgesics prior to discharge. Conclusions: Regional anesthesia achieved with a forearm tourniquet and intravenous local anesthetic provides adequate pain control, permits timely discharge home, and has a low complication rate. It should be considered for use in outpatient hand procedures.

WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial

“…However, they considered that IVRA was successful due to avoidance of conversion to general anesthesia because of insufficient analgesia. [26][27][28][29] All the results found in our study were in agreement with the results from a randomized trial among 24 patients with bilateral CTS who were operated on one hand using WALANT and on the contralateral hand using the IVRA method. The outcomes were pain, expectations and feelings about the reoperation.…”

Wide Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block, in Internal Fixation of Unstable Metacarpal and Phalangeal Fractures of the Hand: A Comparative Study

“…Brachial plexus anesthesia requires specialized operator, patients must be in monitor to avoid complication(pneumothorax) and this is not successful in all cases [25] . Bier's block (with or without supplemental sedation or analgesia) with arm or forearm tourniquet is the most common type of local anesthesia in hand surgery but presents all complications of tourniquet's application and system lidocaine toxicity [24,26] . Many studies have described the complications (post-tourniquet thrombosis, bleeding, postoperative pain, blisters, skin burn, ischemia and reperfusion, neuromuscular damage) of tourniquet when application is more than twenty minutes, which additionally aggravates rehabilitation of the initial injury [26,29,32] .…”

Intravenous regional anesthesia (IVRA) with forearm tourniquet for short-term hand surgery: A case report

“…More local anesthetic agents and sedo-analgesia are used after tourniquet pain develops; however, this approach may pose a risk in terms of early tourniquet deflation in distal region operations and short surgeries. Risks during surgery can be minimized by limiting the ischemic area and reducing the amount of local anesthetic with the forearm tourniquet even in the event of possible leakage [5].…”