Progression of Forearm Intravenous Regional Anesthesia With Ropivacaine

Abstract

The progression of sensory blockade in the hand following a forearm Bier block with ropivacaine is currently unknown. The hands of 10 healthy adult human subjects were anesthetized with ropivacaine, and their sensitivities to cold and touch were tested until the completion of anesthesia. On average, insensitivity to cold occurred uniformly throughout the hand within 9 mins; however, touch sensation was not complete until approximately 20 mins after injection. The spread of anesthesia occurred in a semisystematic way, spreading proximally and distally from the site of injection (mid-dorsum of the hand), and, at a slower rate, from the dorsum of the hand to the palm.

The Effects of Mepivacaine Hydrochloride on Antimicrobial Activity and Mechanical Nociceptive Threshold During Amikacin Sulfate Regional Limb Perfusion in the Horse

“…The use of local anesthetics in regional limb perfusion has been used extensively in cattle for distal limb surgical procedures and is commonly referred to as the Bier block . In addition, regional limb perfusions of local anesthetics are used routinely in limb surgery in human medicine . In our clinical experience with horses, the addition of mepivacaine hydrochloride to a regional limb perfusion during laceration repair appears to provide analgesia to the limb and facilitate standing surgical repair.…”

Putting It All Together

“…5,6 Using 20 mL of 0.3% ropivacaine intravenously for a Bier block, temperature insensitivity was affected approximately 9 minutes following injection, whereas pain insensitivity occurred after approximately 20 minutes. 5 More recent modifications suggest that a single and temporary tourniquet distal to the elbow is not only sufficient to concentrate the local anesthetic but also safe without systemic effects. In a retrospective study using 25 mL of 0.5% lidocaine for a Bier block for 105 patients undergoing hand surgery, the average tourniquet time was 10.1 minutes without systemic toxicity or complications.…”