Intravenous Regional Anesthesia
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.
KeywordsRegional anesthesia Forearm tourniquet IVRA Local anesthetic Complex regional pain syndrome NSAIDs Motor blockade
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