title: Intra-arterial regional anaesthesia for hand surgery with alkalinized 0.5% lignocaine.
abstract: Intra-arterial regional anaesthesia (IARA) for hand surgery is an old, forgotten technique. One of the causes of low popularity may be a scalding sensation in the hand during intra-arterial injection of lignocaine, which may be caused by low pH of lignocaine's solution. In this randomized, double-blind study, normal (pH 5.2-5.3) or alkalinized (pH 7.2-7.3) preservative-free 0.5% lignocaine 1.5 mg kg-1 was injected into the radial arteries of forty adult patients to produce anaesthesia for ambulatory hand surgery. Scalding sensation in the hand during intra-arterial injection (VAS) was less pronounced with alkalinized lignocaine (P = 0.04). The time of onset and regression of analgesia was similar in both groups. Four patients in group 1 (normal lignocaine) and six patients in group 2 (alkalinized lignocaine) needed supplemental analgesia at the start of surgery (NS). Cannulation time, operating conditions, motor blockade, surgical-, and tourniquet pain scores (VAS) and patient's acceptance were similar. Three patients (two in group 1 and one in group 2) had minor systemic adverse effects after tourniquet release (NS). Nine patients in group 1 and seven in group 2 developed minor bruises after cannulation (NS). No other sequelae of intra-arterial injections were observed. We conclude that alkalinized 0.5% lignocaine was less painful on injection than normal lignocaine and should be preferred for intra-arterial anaesthesia for hand surgery.
authors.affiliation: Department of Anaesthesia, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Koscielniak-Nielsen
authors.forename: H L
authors.initials: HL
authors.lastname: Stens-Pedersen
authors.forename: E J
authors.initials: EJ
authors.lastname: Kjaerbo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007269:Injections, Intra-Arterial; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine