Single-cuff forearm tourniquet in intravenous regional anaesthesia results in less pain and fewer sedation requirements than upper arm tourniquet

Chiao, Franklin; Chen, J; Lesser, Jonathan B.; Resta-Flarer, Francesco; Bennett, Henry L.

doi:10.1093/bja/aet032

Cited by 29 publications

(23 citation statements)

References 17 publications

(5 reference statements)

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“…One article was retracted because of fabricated data and 15 full-text articles were assessed. After exclusion of ineligible studies, 3 RCT’s were included in the qualitative and quantitative synthesis [ 7 , 20 , 21 ]. Finally, 4 articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA.…”

Section: Resultsmentioning

confidence: 99%

“…This technique, introduced by Dr. August Bier in 1908, provides complete anesthesia as well as a bloodless field during surgery [ 6 ]. Traditionally, an upper arm tourniquet has been used to sequester the local anesthetic and to create a bloodless surgical field [ 7 ]. Major complications after IVRA with an upper arm tourniquet are rare but are mostly related to local anesthetic systemic toxicity after release of the tourniquet [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

et al. 2018

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BackgroundThe main objective of this review is to perform a systematic review and meta-analysis of the existing evidence related to the analgesic efficacy with the use of conventional, upper arm intravenous regional anesthesia (IVRA) as compared to a modified, forearm IVRA in adult patients undergoing procedures on the distal upper extremity.MethodsMEDLINE, EMBASE and CENTRAL (Cochrane) databases were searched for randomized controlled trials published in English, French, Dutch, German or Spanish language. Primary outcomes of interest including description of quality level of anesthesia and onset of sensory block were assessed for this review. Dosage of the local anesthetic, local anesthetic toxicity and need for sedation due to tourniquet pain were considered as secondary outcomes.ResultsOur literature search yielded 3 papers for qualitative synthesis. Four other articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA. Forearm IVRA was found to be as efficient as upper arm IVRA (RR = 0.98 [0.93, 1.05], P = 0.78), but comes with the advantage of a lower need for sedation due to less tourniquet pain.ConclusionOur results demonstrate that forearm IVRA is as effective in providing a surgical block as compared to a conventional upper arm IVRA, even with a reduced, non-toxic dosage of local anesthetic. No severe complications were associated with the use of a forearm IVRA. Other benefits of the modified technique include a faster onset of sensory block, better tourniquet tolerance and a dryer surgical field.Registration of the systematic reviewA review protocol was published in the PROSPERO register in November 2015 with registration number CRD42015029536.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

et al. 2018

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“…Administering IVRA requires placing a tourniquet. Human patients commonly experience tourniquet pain within 30 min after placement [ 39 , 52 – 54 ]. In this study, mean hormonal-metabolic and cardiac stress responses to IVRA and NBA in cows, were of similar magnitude (except the respiratory rate), giving no clear indication of specific pain-related stress responses by either technique.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows

et al. 2017

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BackgroundIntravenous regional anaesthesia (IVRA) and hindfoot four-point nerve block anaesthesia (NBA) are recommended for local anaesthesia (LA) in the distal limb of dairy cows. Two studies were conducted to compare the efficacy, time until onset and stress responses to IVRA and NBA in dairy cows. In the first cross-over designed study, eight healthy unsedated German Holstein cows, restrained in lateral recumbency (LR) on a surgical tipping table, were treated with IVRA and NBA using procaine 2% as a local anaesthetic. Distal limb desensitization was tested by electrical (e-), mechanical (m-) and thermal (t-) nociceptive stimulation 10 min before and 15 and 30 min after LA. Hormonal-metabolic (blood concentrations of cortisol, lactate, non-esterified fatty acids, and glucose) and cardio-respiratory (heart and respiratory rate, mean arterial blood pressure) stress responses to treatment were assessed at predetermined intervals. In the second study, six healthy, unsedated German Holstein cows in LR were treated (crossover design) with IVRA and NBA. Short-interval e-stimulation was measured by the time until complete distal limb desensitization.ResultsIn the first study, four of eight cows responded to e-stimulation 15 min after IVRA, while none of the cows treated with NBA responded until the safety cut-off level was reached. E-stimulation revealed complete desensitization of the distal limb 30 min after LA in all cows. Half of the cows did not respond to m- and t-stimulation before LA, so no further evaluation was performed. Stress reactions to IVRA and NBA treatment were similar, but differences may have been masked by stress response to LR restraint. In the second study, complete desensitization was achieved 12.5 min after NBA, while one of the six cows still responded to e-stimulation 20 min after IVRA.ConclusionHindfoot nerve block anaesthesia and intravenous regional anaesthesia induced complete desensitization of the distal hind limb in dairy cows. However, the anaesthesia onset after NBA was significantly faster than that of IVRA, which may be clinically relevant in the field, particularly when distal limb anaesthesia is required for major claw surgeries under time constraints.

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“…Due to the risk of systemic local anesthetic toxicity, lidocaine is the agent of choice due to its relatively low cardiac toxicity. Application of Regional Anesthesia for Hand Surgeries http://dx.doi.org/10.5772/intechopen.76786 forearm tourniquet for hand or finger surgeries may be more comfortable for the patients and also can potentially reduce the amount of local anesthetic intravenously in IVRA [9].…”

Section: Technique Of Ivramentioning

confidence: 99%

Regional Anesthesia for Hand Surgeries

Shanthanna¹,

Rajarathinam²

2018

Essentials of Hand Surgery

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Anesthesia for hand surgeries is one of the domains of regional anesthesia, where it plays the role, not only as a viable alternative to GA but also as an adjunct to it. The efficacy and inherent advantages of regional anesthesia techniques are widely made use of by the hand and upper limb surgical centers across the world. There are a variety of established regional techniques ranging from major plexus blocks to local infiltration techniques and intra venous regional anesthesia for hand surgeries. The peripheral nerve blocks are recently being performed with ultrasound guidance which is undoubtedly the greatest influence till date in the practice of modern regional anesthesia. There is also a recent trend in the performance of certain minor hand surgeries (e.g., carpal tunnel release) under infiltrative techniques in office-like settings for rapid turnover. This chapter discusses concisely the selection and execution of such techniques in day-today practice.

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Single-cuff forearm tourniquet in intravenous regional anaesthesia results in less pain and fewer sedation requirements than upper arm tourniquet

Abstract: Our results indicate that the placement of the tourniquet on the forearm resulted in less discomfort, fewer sedation interventions, and greater likelihood of bypassing the PACU when compared with upper arm tourniquet.

Cited by 29 publications

References 17 publications

The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows

Regional Anesthesia for Hand Surgeries

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