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Intravenous Regional Anesthesia

  • Lindsey Vokach-Brodsky
  • Vibhav B. Reddy
  • Kathryn Teixeira
  • Elyse M. Cornett
  • Julie Gayle
  • Patricia B. Sutker
  • Alan David Kaye
Chapter

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.

Keywords

Regional anesthesia Forearm tourniquet IVRA Local anesthetic Complex regional pain syndrome NSAIDs Motor blockade 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lindsey Vokach-Brodsky
    • 1
  • Vibhav B. Reddy
    • 2
  • Kathryn Teixeira
    • 3
  • Elyse M. Cornett
    • 4
  • Julie Gayle
    • 5
  • Patricia B. Sutker
    • 5
  • Alan David Kaye
    • 6
  1. 1.Department of Anesthesiology, Perioperative and Pain MedicineStanford UniversityStanfordUSA
  2. 2.Department of AnesthesiologyTulane UniversityNew OrleansUSA
  3. 3.Department of AnesthesiologyTulane University Medical CenterNew OrleansUSA
  4. 4.Department of AnesthesiologyLouisiana State University Health Sciences Center—ShreveportShreveportUSA
  5. 5.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA
  6. 6.Department of AnesthesiologyLouisiana State University School of MedicineNew OrleansUSA

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