Abstract
In an attempt to reduce the dose of local anaesthetic agent during intravenous regional anaesthesia (IVRA) of the upper limb, we have used a forearm tourniquet in 12 adult volunteers. The volume of the forearm venous system was predetermined angiographically. We performed IVRA with three solutions of lidocaine (0.25, 0.375, 0.5 per cent) administered in a volume equal to the forearm venous system. Angiographic results indicate that: a forearm tourniquet provides adequate vascular isolation; the volume of the forearm venous system can be correlated with body weight; the progression of the fluid in the venous system follows a pattern that is similar for all patients with the small veins of the distal forearm and proximal hand being filled last. With this technique, lidocaine 0.5 per cent resulted in a dose of Umgkg−1 and provided excellent analgesia. Lower concentrations were unsatisfactory. We conclude that the use of a forearm tourniquet allows reduction of the local anaesthetic dose to a nontoxic level and thus increases the safety of IVRA.
Résumé
Afin de réduire la dose d’anesthisique local lors du bloc veineux (BV) du membre supirieur, nous avons érudié l’utilisation d’un tourniquet sur l’avant-bras chez 12 volontaires. Nous avons effectui des BV avec trois concentrations de lidocaine (0.25, 0.375, 0.5 pour cent), utilisant un volume d’anesthésique local egal au volume du réseau veineux de l’avant-bras précédemment determiné par angiographie. Les donnees angiographiques montrent que: le tourniquet place sur l’avant-bras assure un blocage vasculaire adéquat; le volume du riseau veineux de l’avant-bras peut etre pridit a partir du poids corporel; laprogression du liquide dans le réseau veineux suit une sequence uniforme d’un patient à l’autre, les petites veines de l’avant-bras distal et de la main se remplissant les dernières. Lutilisation de lidocaine 0.5 pour cent avec cette technique resulte en une dose totale de 1.5 mg. kg−1 et produit une excellente analgésie. Nous concluons que l’usage d’un tourniquet sur l’avant-bras réduit le risque dintoxication a l’ anesthésique local et contribue a rendre plus sécuritaire l’anesthésie régionale intraveineuse avec la lidocaine.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Thorn-Alquist AM. Intravenous regional anaesthesia - a seven year survey. Acta Anaesth Scand (Suppl) 1971; 15: 23–32.
Harris WH, Slater EM, Bell HM. Regional anesthesia by the intravenous route. JAMA 1965; 194: 105–8.
Heath ML. Bupivacaine toxicity and Bier blocks. Anesthesiology 1983; 59: 481.
Mazze RI, Dunbar RW. Plasma lidocaine concentrations after caudal, lumbar epidural, axillary block and intravenous regional anesthesia. Anesthesiology 1966; 27: 574–9.
Urban BJ, McKain CW. Onset and progression of intravenous regional anesthesia with dilute lidocaine. Anesth Analg 1982; 61: 834–8.
Chan CS, Pun WK, Chan YM. Intravenous regional analgesia with a forearm tourniquet. Can J Anaesth 1987; 34: 21–5.
Sanders R. The tourniquet, instrument or weapon? The Hand 1973; 5: 119–23.
Bolton CF, McFarlane RM. Human pneumatic tourniquet paralysis. Neurology 1978; 28: 787–93.
Dornette WHL. Compression neuropathies: medical aspects and legal implications.In: Neurological and Psychological Complications of Surgery and Anesthesia. BJ Hindman (Ed.). International Anesthesiology Clinics 1986; 24: 201–29.
Medical Research Council. Aids to the examination of the peripheral nervous system, London, Her Majesty’s Stationery Office. 1976; Memorandum #45.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Plourde, G., Barry, PP., Tardif, L. et al. Decreasing the toxic potential of intravenous regional anaesthesia. Can J Anaesth 36, 498–502 (1989). https://doi.org/10.1007/BF03005374
Issue Date:
DOI: https://doi.org/10.1007/BF03005374