Complications of Intravenous Regional Anesthesia

  • Dominic A. Cave
  • Barry A. Finegan
Chapter

Abstract

Intravenous regional anesthesia (IVRA) of the limb was first described by Bier in 1908.1 The original technique involved the surgical exposure of, and direct injection of local anesthetic into, an antecubital vessel, of an exsanguinated and isolated upper limb, thereby rendering the tissue below the applied tourniquet insensitive to pain. IVRA is a simple and effective method of providing anesthesia to peripheral tissues that anatomically have a blood supply which can be occluded by a pneumatic cuff. The technique in use today consists of the placement of a catheter in a suitable vein before exsanguination of the surgical site by gravity or compression, the inflation of a pneumatic double tourniquet, and the injection of a local anesthetic into the venous system of the isolated limb. Serious IVRA-related complications are rare and can be classified as drug and tourniquet related.2

Keywords

Compartment Syndrome Complex Regional Pain Syndrome Reflex Sympathetic Dystrophy Central Nervous System Toxicity Neuromuscular Blocking Drug 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bier A. Uber einen neuen weg lokalanasthesie an den gliedmassen zu erzeugen. Verh Dtsch Ges Chir 1908;37:204–214.Google Scholar
  2. 2.
    Brown EM, McGriff JT, Malinowski RW. Intravenous regional anaesthesia (Bier block): review of 20 years’ experience. Can J Anaesth 1989;36(3):307–310.PubMedCrossRefGoogle Scholar
  3. 3.
    Tucker GT. Pharmacokinetics of local anaesthetics. Br J Anaesth 1986;58:717–731.PubMedCrossRefGoogle Scholar
  4. 4.
    Bean BP, Cohen CJ, Tsien RW. Lidocaine block of cardiac sodium channels. J Gen Physioly 1983;5:613–642.CrossRefGoogle Scholar
  5. 5.
    Reiz S, Nath S. Cardiotoxicity of local anaesthetic agents. Br J Anaesth 1986;58: 736–746.PubMedCrossRefGoogle Scholar
  6. 6.
    Nath S, Haggmark S, Johansson G, Reiz S. Differential depressant and electrophysiological cardiotoxicity of local anesthetics: an experimental study with special reference to lidocaine and bupivacaine. Anesth Analg 1986;65:1263–1270.PubMedCrossRefGoogle Scholar
  7. 7.
    Liu P, Covino BM, Giasi R, Covino BG. Acute cardiovascular toxicity of intravenous amide anesthetics in anesthetized ventilated dogs. Anesth Analg 1982;61:317–322.PubMedGoogle Scholar
  8. 8.
    deJong RH, Ronfeld RA, DeRosa RA. Cardiovascular effects of convulsant and supra-convulsant doses of amide local anesthetics. Anesth Analg 1982;61(1):3–9.PubMedGoogle Scholar
  9. 9.
    Enright AC, Smith GG, Wyant GM. Comparison of bupivacaine and lidocaine for intravenous regional analgesia. Can Anaesth Soc J 1980;27(6):553–555.PubMedCrossRefGoogle Scholar
  10. 10.
    Covino BG. Toxicity of local anesthetics. Acta Anaesthesiol Belg 1988;39:159–164.PubMedGoogle Scholar
  11. 11.
    Ware RJ. Intravenous regional analgesia using bupivacaine. A double blind comparison with lignocaine. Anaesthesia 1979;34(3):231–235.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith CA, Steinhaus JE, Haynes CD. The safety and effectiveness of intravenous regional anesthesia. South Med J 1968;61:1057–1060.PubMedCrossRefGoogle Scholar
  13. 13.
    Tucker GT, Boas RA. Pharmacokinetic aspects of intravenous regional anesthesia. Anesthesiology 1971;34:538–549.PubMedCrossRefGoogle Scholar
  14. 14.
    Kern C, Gamulin Z. Generalised convulsions after intravenous regional anaesthesia with prilocaine. Anaesthesia 1994;49(7):642–643.PubMedCrossRefGoogle Scholar
  15. 15.
    Bader AM, Concepcion M, Hurley RJ, Arthur GA. Comparison of lidocaine and prilocaine for intravenous regional anesthesia. Anesthesiology 1988;69(3):409–412.PubMedCrossRefGoogle Scholar
  16. 16.
    Mazze RI, Dunbar RW. Intravenous regional anesthesia — report of 497 cases with toxicity study. Acta Anaesthesiol Scand Suppl 1969;36:27–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Thorn-Alquist AM. Blood concentrations of local anaesthetics after intravenous regional anaesthesia. Acta Anaesthesiol Scand 1969;13(4):229–240.PubMedCrossRefGoogle Scholar
  18. 18.
    Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology 1985;62(4):396–405.PubMedCrossRefGoogle Scholar
  19. 19.
    Ware RJ. Intravenous regional analgesia using bupivacaine. Anesthesia 1975;30(6): 817–822.CrossRefGoogle Scholar
  20. 20.
    Heath ML. Deaths after intravenous regional anaesthesia from bupivacaine. Br Med J (Clin Res Ed) 1982;285(6346):913–914.CrossRefGoogle Scholar
  21. 21.
    Long WB, Rosenblum S, Grady IP. Successful resuscitation of bupivacaine-induced cardiac arrest using cardiopulmonary bypass. Anesth Analg 1989;69(3): 403–406.PubMedCrossRefGoogle Scholar
  22. 22.
    Reynolds F. Bupivacaine and intravenous regional anaesthesia. Anaesthesia 1984;39(2): 105–107.PubMedCrossRefGoogle Scholar
  23. 23.
    Atanassoff PG, Aouad R, Hartmannsgruber M, Halaszynski T. Levobupivacaine 0.125% and lidocaine 0.5% for intravenous regional anesthesia in volunteers. Anesthesiology 2002;97:325–328.PubMedCrossRefGoogle Scholar
  24. 24.
    Huang YF, Pryor ME, Mather LE, Veering BT Cardiovascular and central nervous system effects of intravenous levobupivacaine in sheep. Anesth Analg 1998;86(4): 797–804.PubMedGoogle Scholar
  25. 25.
    Atanassoff PG, Hartmannsgruber M. Central nervous system side effects are less important after IV regional anesthesia with ropivacaine 0.2% compared to lidocaine 0.5% in volunteers. Can J Anaesth 2002;49(2):169–172.PubMedCrossRefGoogle Scholar
  26. 26.
    Peng PW, Coleman MM, McCartney CJ, et al. Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm regional anesthesia. Reg Anesth Pain Med 2002;27(6):595–599.PubMedGoogle Scholar
  27. 27.
    Groban L, Deal DD, Vernon JC, James RL, Butterworth J. Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine and ropivacaine in anesthetized dogs. Anesth Analg 2001;92(1):37–43.PubMedCrossRefGoogle Scholar
  28. 28.
    Biscoping J, Michaelis G, Hempelmann G. Behavior of plasma concentrations of prilocaine following intravenous regional anesthesia and their relation to methemoglobinemia. Reg Anaesth 1988;11:35–39.PubMedGoogle Scholar
  29. 29.
    Harris WH. Choice of anesthetic agents for intravenous regional anesthesia. Acta Anaesthesiol Scand Suppl 1969;36:47–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Mazze RI. Methemoglobin concentrations following intravenous regional anesthesia. Anesth Analg 1968;47:122–125.PubMedGoogle Scholar
  31. 31.
    Pitkanen MT, Suzuki N, Rosenberg PH. Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chloroprocaine. A double-blind comparison in volunteers. Anaesthesia 1992;47:618–619.PubMedCrossRefGoogle Scholar
  32. 32.
    Schurg R, Biscoping J, Bachmann MB, Hempelmann G. Intravenous regional anesthesia of the foot using prilocaine. Clinical aspects, pharmacokinetic and pharmacodynamic studies. Reg Anaesth 1990;13:118–121.PubMedGoogle Scholar
  33. 33.
    Bartholomew K, Sloan J P. Prilocaine for Bier’s block: how safe is safe? Arch Emerg Med 1990;7:189–195.PubMedGoogle Scholar
  34. 34.
    Arendt-Nielsen L, Oberg B, Bjerring P. Laser-induced pain for quantitative comparison of intravenous regional anesthesia using saline, morphine, lidocaine, or prilocaine. Reg Anesth 1990;15:186–193.PubMedGoogle Scholar
  35. 35.
    Suzuki N, Pitkanen M, Sariola H, Palas T, Rosenberg PH. The effect of plain 0.5% 2-chloroprocaine on venous endothelium after intravenous regional anaesthesia in the rabbit. Acta Anaesthesiol Scand 1994;38:653–656.PubMedCrossRefGoogle Scholar
  36. 36.
    Palas TA. Don’t forget chloroprocaine for IVRA. Reg Anesth 1990;15:271.PubMedGoogle Scholar
  37. 37.
    Pitkanen MT, Suzuki N, Rosenberg PH. Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chloroprocaine. Anaesthesia 1992;47:618–619.PubMedCrossRefGoogle Scholar
  38. 38.
    Pitkanen MT, Xu M, Haasio J, Rosenberg PH. Comparison of 0.5% articaine and 0.5% prilocaine in intravenous regional anesthesia of the arm: a cross-over study in volunteers. Reg Anaesth Pain Med 1999;24(2):131–135.Google Scholar
  39. 39.
    Prieto-Alvarez P, Calas-Guerra A, Fuentes-Bellido J, Martinez-Verdera E, Benet-Catala A, Lorenzo-Foz JP. Comparison of mepivacaine and lidocaine for intravenous regional anaesthesia: pharmacokinetic study and clinical correlation. Br J Anaesth 2002;88(4): 516–519.PubMedCrossRefGoogle Scholar
  40. 40.
    Amiot JF, Bouju P, Palacci JH, Ballinere E. Intravenous regional anaesthesia with ketamine. Anaesthesia 1985;40:899–901.PubMedCrossRefGoogle Scholar
  41. 41.
    Durrani Z, Winnie AP, Zsigmond EK, Burnett ML. Ketamine for intravenous regional anesthesia [see comments]. Anesth Analg 1989;68:328–332.PubMedCrossRefGoogle Scholar
  42. 42.
    Gorgias NK, Maidatsi PG, Kyriakidis AM, Karakoulas KA, Alvanos DN, Giala MM. Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine. Reg Anesth Pain Med 2001;26:512–517.PubMedGoogle Scholar
  43. 43.
    Hannington-Kiff JG. Intravenous regional sympathetic block with guanethidine. Lancet 1974:1019–1020.Google Scholar
  44. 44.
    Blanchard J, Ramamurthy S, Walsh N, Hoffman J, Schoenfeld L. Intravenous regional sympatholysis: a double-blind comparison of guanethidine, reserpine and normal saline. J Pain Symptom Manage 1990;5:357–361.PubMedCrossRefGoogle Scholar
  45. 45.
    Walker SM, Cousins MJ. Complex regional pain syndromes: including “reflex sympathetic dystrophy” and “causalgia”. Anaesth Intensive Care 1997;25:113–125.PubMedGoogle Scholar
  46. 46.
    Hannington-Kiff JG. Rheumatoid arthritis — interventional treatment with regionally applied drugs and the use of sympathetic modulation: discussion paper. J R Soc Med 1990;83:373–376.PubMedGoogle Scholar
  47. 47.
    Kaplan R, Thomas P, Tepper H, Strauch B. The treatment of frostbite with guanethidine. Lancet 1981;2(8252):940–941.PubMedGoogle Scholar
  48. 48.
    Aarts HF. Regional intravascular sympathetic blockade for better results in flap surgery. An experimental study of free flaps, island flaps, and pedicle flaps in the rabbit ear. Plast Reconstr Surg 1980;66:690–698.PubMedCrossRefGoogle Scholar
  49. 49.
    Jadad AR, Carroll D, Glynn CJ, McQuay HJ. Intravenous regional blockade for pain relief in reflex sympathetic dystrophy: a systematic review and a randomized double-blind crossover study. J Pain Symptom Manage 1995;10:13–20.PubMedCrossRefGoogle Scholar
  50. 50.
    Coffman JD. Drug therapy: vasodilator drugs in peripheral vascular disease. N Engl J Med 1979;300:713–717.PubMedCrossRefGoogle Scholar
  51. 51.
    Hannington-Kiff JG. Pharmacological target blocks in hand surgery. J Hand Surg Br 1984;9:29–36.PubMedCrossRefGoogle Scholar
  52. 52.
    Sharpe E, Milaszkiewicz R, Carli F. A case of prolonged hypotension following intravenous guanethidine block. Anaesthesia 1987;42:1081–1084.PubMedCrossRefGoogle Scholar
  53. 53.
    Woo R, McQueen J. Apnea and syncope following intravenous guanethidine Bier block in the same patient on two different occasions. Anesthesiology 1987;67:281–282.PubMedCrossRefGoogle Scholar
  54. 54.
    Kalmanovitch DVA, Hardwick PB. Hypotension after guanethidine block. Anaesthesia 1988;43:256.PubMedCrossRefGoogle Scholar
  55. 55.
    Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth 2002;49(1):32–45.PubMedCrossRefGoogle Scholar
  56. 56.
    Armstrong P, Power I, Wildsmith JA. Addition of fentanyl to prilocaine for intravenous regional anaesthesia. Anaesthesia 1991;46:278–280.PubMedCrossRefGoogle Scholar
  57. 57.
    Arthur JM, Heavner JE, Mian T, Rosenberg PH. Fentanyl and lidocaine versus lidocaine for Bier block. Reg Anesth 1992;17:223–227.PubMedGoogle Scholar
  58. 58.
    McGlone R, Heyes F, Harris P. The use of muscle relaxant to supplement local anaesthetics for Bier’s blocks. Arch Emerg Med 1988;5:79–85.PubMedGoogle Scholar
  59. 59.
    Elhakim M, Sadek RA. Addition of atracurium to lidocaine for intravenous regional anaesthesia. Acta Anaesthesiol Scand 1994;38:542–544.PubMedCrossRefGoogle Scholar
  60. 60.
    Reuben SS, Steinberg RB, Kreitzer JM, Duprat KM. Intravenous regional anesthesia using lidocaine and ketorolac. Anesth Analg 1995;81:110–113.PubMedGoogle Scholar
  61. 61.
    Steinberg RB, Reuben SS, Gardner G. The dose-response relationship of ketorolac as a component of intravenous regional anesthesia with lidocaine. Anesth Analg 1998;86: 791–793.PubMedGoogle Scholar
  62. 62.
    Jones NC, Pugh SC. The addition of tenoxicam to prilocaine for intravenous regional anesthesia. Anaesthesia 1996;51:446–448.PubMedCrossRefGoogle Scholar
  63. 63.
    Corpataux J-B, Van Gissel EF, Donald FA, Forster A, Gamulin Z. Effect on postoperative analgesia of small-dose lysine acetylsalicylate added to prilocaine during intravenous regional anesthesia. Anesth Analg 1997;84:1081–1085.PubMedGoogle Scholar
  64. 64.
    Reuben SS, Steinberg RB, Klatt JL, Klatt ML. Intravenous regional anesthesia using lidocaine and Clonidine. Anesthesiology 1999;91:654–658.PubMedCrossRefGoogle Scholar
  65. 65.
    Gentili M, Bernard J-M, Bonnet F. Adding Clonidine to lidocaine for intravenous regional anesthesia prevents tourniquet pain. Anesth Analg 1999;88(6):1327–1330.PubMedGoogle Scholar
  66. 66.
    Kleinschmidt S, Stockl W, Wilhelm W, Larsen R. The addition of Clonidine to prilocaine for intravenous regional anaesthesia. Eur J Anaesthesiol 1997;14:40–46.PubMedCrossRefGoogle Scholar
  67. 67.
    Memis D, Turan A, Karamanhoglu B, Pamukcu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004;98:835–840.PubMedGoogle Scholar
  68. 68.
    Turan A, Karamanlyoglu B, Memis D, Kaya G, Pamukcu Z. Intravenous regional anesthesia using prilocaine and neostigmine. Anesth Analg 2002;95:1419–1422.PubMedCrossRefGoogle Scholar
  69. 69.
    Robinson DA, Shimmings KI. Uncomplicated accidental early tourniquet deflation during intravenous regional anaesthesia with prilocaine. Anaesthesia 1989;44(1): 83–84.PubMedCrossRefGoogle Scholar
  70. 70.
    Aronson HB, Vatashsky E. Inadvertent tourniquet release five minutes after intravenous regional bupivacaine. Anaesthesia 1980;35:1208–1210.PubMedCrossRefGoogle Scholar
  71. 71.
    Mazze RI, Dunbar RW. Plasma lidocaine concentrations after caudal, lumbar epidural, axillary block, and intravenous regional anesthesia. Anesthesiology1966;27(5): 574–679.PubMedCrossRefGoogle Scholar
  72. 72.
    Dunbar RW, Mazze RI. Intravenous regional anesthesia: experience with 779 cases. Anesth Analg 1967;46(6):806–813.PubMedCrossRefGoogle Scholar
  73. 73.
    Davies JA, Walford AJ. Intravenous regional anaesthesia for foot surgery. Acta Anaesthesiol Scand 1986;30:145–147.PubMedCrossRefGoogle Scholar
  74. 74.
    Quinton DN, Hughes J, Mace PF, Aitkenhead AR. Prilocaine leakage during tourniquet inflation in intravenous regional anaesthesia: the influence of fracture manipulation. Injury 1988;19:333–335.PubMedCrossRefGoogle Scholar
  75. 75.
    Kim DD, Shuman C, Sadr B. Intravenous regional anesthesia for outpatient foot and ankle surgery: a prospective study. Orthopedics 1993;16:1109–1113.PubMedGoogle Scholar
  76. 76.
    Cotev S, Robin GC. Experimental studies on intravenous regional anaesthesia using radioactive lignocaine. Br J Anaesth 1966;38(12):936–940.PubMedCrossRefGoogle Scholar
  77. 77.
    Lawes EG, Johnson T, Pritchard P, Robbins P. Venous pressures during simulated Bier’s block. Anaesthesia 1984;39:147–149.PubMedCrossRefGoogle Scholar
  78. 78.
    Davies J, Hall I, Wilkey A, et al. Intravenous regional analgesia. The danger of the congested arm and the value of occlusion pressure. Anaesthesia 1984;39:416–421.PubMedCrossRefGoogle Scholar
  79. 79.
    Valli H, Rosenberg PH, Kytta J, et al. Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia. Acta Anaesthesiol Scand 1987; 31:279–283.PubMedCrossRefGoogle Scholar
  80. 80.
    Ogden PN. Failure of intravenous regional analgesia using a double cuff tourniquet. Anaesthesia 1984;39:456–459.PubMedCrossRefGoogle Scholar
  81. 81.
    Sukhani R, Garcia CJ, Munhall RJ, et al. Lidocaine disposition following intravenous regional anesthesia with different tourniquet deflation technics. Anesth Analg 1989; 68:633–637.PubMedGoogle Scholar
  82. 82.
    Hargrove RL, Hoyle JR, Boyes RN, et al. Bloodlevels of local anesthetics following intravenous regional anesthesia. Acta Anaesthesiol Scand Suppl 1969;36: 115–120.PubMedCrossRefGoogle Scholar
  83. 83.
    Thorn-Alquist AM. Blood concentrations of local anaesthetics after intravenous regional anaesthesia. Acta Anaesthesiol Scand 1969;13:229–240.PubMedCrossRefGoogle Scholar
  84. 84.
    Hargrove RL, Hoyle JR, Parker JB. Blood lignocaine levels following intravenous regional analgesia. Anaesthesia 1966;21(1):37–41.PubMedCrossRefGoogle Scholar
  85. 85.
    Estebe J-P, Gentili ME, Langlois G, Mouilleron P, Bernard F, Ecoffey C. Lidocaine priming reduces tourniquet pain during intravenous regional anesthesia: a preliminary study. Reg Anesth Pain Med 2003;28(2):120–123.PubMedGoogle Scholar
  86. 86.
    Perlas A, Peng PW, Plaza MB, Middleton WJ, Chan VW, Sanandaji K. Forearm rescue cuff improves tourniquet tolerance during intravenous regional anesthesia. Reg Anesth Pain Med 2003;28(2):98–102.PubMedGoogle Scholar
  87. 87.
    Love BR. The tourniquet. ANZ J Surg 1978;48(1):66–70.CrossRefGoogle Scholar
  88. 88.
    Bolton CF, McFarlane RM. Human pneumatic tourniquet paralysis. Neurology 1978; 28(8):787–793.PubMedGoogle Scholar
  89. 89.
    Larsen UT, Hommelgaard P. Pneumatic tourniquet paralysis following intravenous regional analgesia. Anaesthesia 1987;42(5):526–528.PubMedCrossRefGoogle Scholar
  90. 90.
    Mabee JR, Bostwick TL, Burke MK. Iatrogenic compartment syndrome from hypertonic saline injection in Bier block. J Emerg Med 1994;12(4):473–476.PubMedCrossRefGoogle Scholar
  91. 91.
    Quigley JT, Popich GA, Lanz UB. Compartment syndrome of the forearm and hand: a case report. Clin Orthop Relat Res 1981;(161):247–251.Google Scholar
  92. 92.
    Maletis GB, Watson RC, Scott S. Compartment syndrome. A complication of intravenous regional anesthesia in the reduction of lower leg shaft fractures. Orthopedics 1989; 12(6):841–846.PubMedGoogle Scholar
  93. 93.
    Hastings H 2nd, Misamore G. Compartment syndrome resulting from intravenous regional anesthesia. J Hand Surg 1987;12(4):559–562.Google Scholar
  94. 94.
    Luce EA, Mangubat E. Loss of hand and forearm following Bier block: a case report. J Hand Surg [Am] 1983;8(3):280–283.Google Scholar
  95. 95.
    Pitkanen M, Kytta J, Rosenberg PH. Comparison of 2-chloroprocaine and prilocaine for intravenous regional anaesthesia of the arm: a clinical study. Anaesthesia 1993;48(12): 1091–1093.PubMedCrossRefGoogle Scholar
  96. 96.
    Armstrong P, Brockway M, Wildsmith JA. Alkalinisation of prilocaine for intravenous regional anaesthesia. Anaesthesia 1990;45(1):11–13.PubMedCrossRefGoogle Scholar
  97. 97.
    Paul DL, Logan MR, Wildsmith JA. The effects of injected solution temperature on intravenous regional anaesthesia. Anaesthesia 1988;43(5):362–364.PubMedCrossRefGoogle Scholar
  98. 98.
    Prien T, Goeters C. Intravenous regional anesthesia of the arm and foot using 0.5, 0.75 and 1.0 percent prilocaine. Anasth Intensivther Notfallmed 1990;25(1):59–63.PubMedCrossRefGoogle Scholar
  99. 99.
    Armstrong P, Watters J, Whitfield A. Alkalinisation of prilocaine for intravenous regional anaesthesia. Suitability for clinical use. Anaesthesia 1990;45(11):935–937.PubMedCrossRefGoogle Scholar
  100. 100.
    Plourde G, Barry PP, Tardif L, et al. Decreasing the toxic potential of intravenous regional anaesthesia. Can J Anaesth 1989;36(5):498–502.PubMedCrossRefGoogle Scholar
  101. 101.
    Colizza WA, Said E. Intravenous regional anesthesia in the treatment of forearm and wrist fractures and dislocations in children. Can J Surg 1993;36(3):225–228.PubMedGoogle Scholar
  102. 102.
    Turner PL, Batten J B, Hjorth D, et al. Intravenous regional anaesthesia for the treatment of upper limb injuries in childhood. ANZ J Surg 1986;56(2):153–155.CrossRefGoogle Scholar
  103. 103.
    Plourde G, Barry P-P, Tardif L, Lepage Y, Hardy J-F. Decreasing the toxic potential of intravenous regional anaesthesia. Can J Anaesth 1989;36(5):498–502.PubMedCrossRefGoogle Scholar
  104. 104.
    Karalezli N, Karalezli K, Iltar S, Cimen O, Aydogan N. Results of intravenous regional anaesthesia with distal forearm application. Acta Orthop Belg 2004;70: 401–405.PubMedGoogle Scholar
  105. 105.
    Reuben SS, Steinberg RB, Maciolek H, Manikantan P. An evaluation of the analgesic efficacy of intravenous regional anesthesia with lidocaine and ketorolac using a forearm versus upper arm tourniquet. Anesth Analg 2004;95:457–460.Google Scholar
  106. 106.
    El-Hassan KM, Hutton P, Black AM. Venous pressure and arm volume changes during simulated Bier’s block. Anaesthesia 1984;39(3):229–235.PubMedCrossRefGoogle Scholar
  107. 107.
    Brill S, Middleton W, Brill G, Fisher A. Bier’s block: 100 years old and still going strong! Acta Anaesthesiol Scand 2004;48(1):117–122.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Dominic A. Cave
    • 1
  • Barry A. Finegan
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineUniversity of Alberta HospitalEdmontonCanada

Personalised recommendations