title: A comparison of intercuff and single cuff techniques of intravenous regional anaesthesia using 0.5% prilocaine mixed with technetium 99m-labelled BRIDA.
abstract: Intravenous regional anaesthesia of the upper limb is a widely used technique first described by Bier in 1908. The exact site of action of injected local anaesthetic has not been determined. We have performed intravenous regional anaesthesia on volunteers using prilocaine mixed with technetium 99m-labelled 2,4,6 trimethyl-3-bromo iminodiacetic acid. Two different techniques of intravenous regional anaesthesia (the 'normal' cuff and the intercuff techniques) were combined with gamma camera tracking of the radiolabel to determine the site of local anaesthetic action. The onset of action was similar for both techniques. The local anaesthetic was mainly retained in the antecubital fossa in both techniques but in the 'normal' technique, the local anaesthetic subsequently showed some retrograde spread. This would suggest that the main site of action of local anaesthetic used for intravenous regional anaesthesia is the larger nerves in the vicinity of the antecubital fossa.
authors.affiliation: Anaesthetic Department, Royal Hospital Haslar, Gosport, Hants, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Risdall
authors.forename: P C
authors.initials: PC
authors.lastname: Young
authors.forename: D A
authors.initials: DA
authors.lastname: Jones
authors.forename: D A
authors.initials: DA
authors.lastname: Hett
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D000779:Anesthetics, Local / Q000493:pharmacokinetics*; D000814:Aniline Compounds; D005260:Female; D005542:Forearm; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008297:Male; D015609:Organotechnetium Compounds; D011318:Prilocaine / Q000493:pharmacokinetics*; D012677:Sensation; D014111:Tourniquets
chemical_list: D000779:Anesthetics, Local; D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D011318:Prilocaine; C034837:technetium Tc 99m mebrofenin; D005998:Glycine