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Intravenous Regional Anesthesia

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Essentials of Regional Anesthesia

Abstract

Over a century ago, intravenous regional anesthesia (IVRA) was first described and still remains a valuable technique for numerous surgical procedures. Utilization of a tourniquet on the forearm reduces the volume of anesthetic required and enhances the overall safety of the procedure. The most commonly used anesthetics are lidocaine and prilocaine for IVRA. Clinically α-agonists, such as clonidine and dexmedetomidine, and the 5-HT3 antagonist ondansetron have been studied to enhance blockade. IVRA with guanethidine or bretylium has been used in the treatment of complex regional pain syndromes, although multiple recent reviews of controlled trials, including a 2016 update to a Cochrane systematic review, have failed to show any significant benefit for this treatment modality. The most concerning potential complications of IVRA relate to systemic local anesthetic toxicity.

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References

  1. Cave DA, Finegan BA. Complications of intravenous regional anesthesia. In:Complications of regional anesthesia. New York, NY: Springer New York; 2007. p. 211–23.

    Chapter  Google Scholar 

  2. Holmes C. Intravenous regional analgesia a useful method of producing analgesia of the limbs. Lancet. 1963;281(7275):245–7.

    Article  Google Scholar 

  3. Baranowski AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia. 1990;45(5):362–5.

    Article  CAS  PubMed  Google Scholar 

  4. Tuominen MK, Pitkänen MT, Numminen MK, Rosenberg PH. Quality of axillary brachial plexus block. Comparison of success rate using perivascular and nerve stimulator techniques. Anaesthesia. 1987;42(1):20–2.

    Article  CAS  PubMed  Google Scholar 

  5. Bartholomew K, Sloan JP. Prilocaine for Bier’s block: how safe is safe? Arch Emerg Med. 1990;7(3):189–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87(3):479–86.

    Article  CAS  PubMed  Google Scholar 

  7. Farag E, Mounir-Soliman L, Preceded by (work): Brown, DL. Brown’s atlas of regional anesthesia. 5th ed. Philadelphia, PA: Elsevier; 2017.

    Google Scholar 

  8. Coleman MM, Peng PW, Regan JM, Chan VW, Hendler AL. Quantitative comparison of leakage under the tourniquet in forearm versus conventional intravenous regional anesthesia. Anesth Analg. 1999;89(6):1482–6.

    CAS  PubMed  Google Scholar 

  9. Brown EM, McGriff JT, Malinowski RW. Intravenous regional anaesthesia (Bier block): review of 20 years’ experience. Can J Anaesth. 1989;36(3):307–10.

    Article  CAS  PubMed  Google Scholar 

  10. Kim DD, Shuman C, Sadr B. Intravenous regional anesthesia for outpatient foot and ankle surgery: a prospective study. Orthopedics. 1993;16(10):1109–13.

    CAS  PubMed  Google Scholar 

  11. Heath ML. Deaths after intravenous regional anaesthesia. Br Med J (Clin Res Ed). 1982;285(6346):913–4.

    Article  CAS  Google Scholar 

  12. Simon MAM, Gielen MJM, Alberink N, Vree TB, van Egmond J. Intravenous regional anesthesia with 0.5% articaine, 0.5% lidocaine, or 0.5% prilocaine: a double-blind randomized clinical study. Reg Anesth Pain Med. 1997;22(1):29–34.

    Article  CAS  Google Scholar 

  13. Bader AM, Concepcion M, Hurley RJ, Arthur GR. Comparison of lidocaine and prilocaine for intravenous regional anesthesia. J Am Soc Anesthesiol. 1988;69(3):409–11.

    Article  CAS  Google Scholar 

  14. Pitkänen 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(7):618–9.

    Article  PubMed  Google Scholar 

  15. Prieto-Alvarez P, Calas-Guerra A, Fuentes-Bellido J, Martínez-Verdera E, Benet-Català A, Lorenzo-Foz JP. Comparison of mepivacaine and lidocaine for intravenous regional anaesthesia: pharmacokinetic study and clinical correlation. Br J Anaesth. 2002;88(4):516–9.

    Article  CAS  PubMed  Google Scholar 

  16. Asik I, Kocum AI, Goktug A, Turhan KS, Alkis N. Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia. J Clin Anesth. 2009;21(6):401–7.

    Article  CAS  PubMed  Google Scholar 

  17. Niemi TT, Neuvonen PJ, Rosenberg PH. Comparison of ropivacaine 2 mg ml-1 and prilocaine 5 mg ml-1 for i.v. regional anaesthesia in outpatient surgery. Br J Anaesth. 2006;96(5):640–4.

    Article  CAS  PubMed  Google Scholar 

  18. Lavin PA, Henderson CL, Vaghadia H. Non-alkalinized and alkalinized 2-chloroprocainevs lidocaine for intravenous regional anesthesia during outpatient hand surgery. Can J Anesth. 1999;46(10):939–45.

    Article  CAS  PubMed  Google Scholar 

  19. Phillips JF, Yates AB, Deshazo RD. Approach to patients with suspected hypersensitivity to local anesthetics. Am J Med Sci. 2007;334(3):190–6.

    Article  PubMed  Google Scholar 

  20. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anesth. 2002;49(1):32–45.

    Article  PubMed  Google Scholar 

  21. Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg. 2004;98(3):835–40. table of contents

    Article  PubMed  Google Scholar 

  22. Honarmand A, Safavi M, Adineh-Mehr L. Effect of adding 8 milligrams ondansetron to lidocaine for Bier’s block on post-operative pain. Adv Biomed Res. 2013;2:52.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Elhakim M, Sadek RA. Addition of atracurium to lidocaine for intravenous regional anaesthesia. Acta Anaesthesiol Scand. 1994;38(6):542–4.

    Article  CAS  PubMed  Google Scholar 

  24. Tran DQH, Duong S, Bertini P, Finlayson RJ. Treatment of complex regional pain syndrome: a review of the evidence. Can J Anesth. 2010;57(2):149–66.

    Article  PubMed  Google Scholar 

  25. Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O’Connell NE. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev. 2013;(8):CD004598T.

    Google Scholar 

  26. O’Connell NE, Wand BM, Gibson W, Carr DB, Birklein F, Stanton TR. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev. 2016;(7):CD004598.

    Google Scholar 

  27. Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications. J Clin Anesth. 2009;21(8):585–94.

    Article  PubMed  Google Scholar 

  28. Gurich RW, Langan JW, Teasdall RJ, Tanner SL, Sanders JL. Tourniquet deflation prior to 20 minutes in upper extremity intravenous regional anesthesia. Hand (N Y); 2017 Jan 1:1558944716686214.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA

    Lindsey Vokach-Brodsky MBChB, FFARCSI

  2. Department of Anesthesiology, Tulane University, New Orleans, LA, USA

    Vibhav B. Reddy MD

  3. Department of Anesthesiology, Tulane University Medical Center, New Orleans, LA, USA

    Kathryn Teixeira MD

  4. Department of Anesthesiology, Louisiana State University Health Sciences Center—Shreveport, Shreveport, LA, USA

    Elyse M. Cornett PhD

  5. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Julie Gayle MD & Patricia B. Sutker PhD

  6. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Alan David Kaye MD, PhD

Authors
  1. Lindsey Vokach-Brodsky MBChB, FFARCSI
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  2. Vibhav B. Reddy MD
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  3. Kathryn Teixeira MD
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  4. Elyse M. Cornett PhD
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  5. Julie Gayle MD
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  6. Patricia B. Sutker PhD
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  7. Alan David Kaye MD, PhD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    Which of the following local anesthetics would be LEAST appropriate for IVRA?

    1. (a)

      Lidocaine

    2. (b)

      Bupivacaine

    3. (c)

      Prilocaine

    4. (d)

      All of the above are appropriate

  2. 2.

    All of the following local anesthetics are used in IVRA (intravenous regional anesthesia) except:

    1. (a)

      Lidocaine

    2. (b)

      Prilocaine

    3. (c)

      Mepivacaine

    4. (d)

      Bupivacaine

  3. 3.

    Clinically significant improvements to IVRA have been achieved by using additives including:

    1. (a)

      Ketorolac

    2. (b)

      Clonidine

    3. (c)

      Dexmedetomidine

    4. (d)

      Ondansetron

    5. (e)

      All of the above

Answers

  1. 1.

    b

  2. 2.

    d

  3. 3.

    e

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Vokach-Brodsky, L. et al. (2018). Intravenous Regional Anesthesia. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_36

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_36

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

  • eBook Packages: MedicineMedicine (R0)

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