Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries.
OBJECTIVE
Local anesthetic toxicity remains one of the most dreaded complications of the intravenous regional anesthesia (IVRA) technique. It results from the sudden release of a large amount of local anesthetic (LA) into the systemic circulation. This release can occur when the tourniquet deflates accidentally during the procedure or when it is deflated intentionally at the end of the procedure to terminate the anesthesia. The forearm tourniquet IVRA technique may offer distinct advantages over the conventional upper arm tourniquet IVRA technique. Use of a forearm tourniquet allows the dosage of local anesthetic to be decreased to almost half of what is required with an upper arm tourniquet, and the incidence of tourniquet pain has been reported to be less with forearm tourniquet. In this study, authors assessed the clinical efficacy of administering IVRA with lidocaine plus ketorolac using either a forearm or upper arm tourniquet.


METHODS
Upper arm IVRA was established using 0.5% lidocaine at a dose of 3 mg/kg with ketorolac at 0.3 mg/kg. Forearm IVRA was established using 0.5 % lidocaine at a dose of 1.5 mg/kg with ketorolac at 0.15 mg/kg. Quality of surgical anesthesia, onset, duration of sensory block and postoperative surgical pain and analgesic use were recorded and assessed. The incidence of local anesthetic toxicity and local complications due to the tourniquet were also recorded.


RESULTS
Surgical anesthesia was assessed as excellent or good (grade 0/1) in all 20/20 patients who received IVRA using an upper arm tourniquet and in 19/20 patients who received IVRA using a forearm tourniquet (P=1.00). Onset as well as regression of sensory block was similar in both the groups. Post operative VAS scores at 30 min and 60 min were statistically comparable between the two groups, as was the analgesic use in the first 24 h.


CONCLUSIONS
In conclusion, forearm IVRA provides effective perioperative anesthesia and analgesia. The technique results in a similar clinical profile as upper arm IVRA while using half the dose of both lidocaine and ketorolac.
Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
R
R
Singh
A
A
Bhagwat
P
P
Bhadoria
A
A
Kohli
D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001132:Arm / Q000098:blood supply; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D012039:Regional Blood Flow / Q000502:physiology; D014111:Tourniquets / Q000009:adverse effects; D014953:Wrist / Q000601:surgery*; D055815:Young Adult
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008012:Lidocaine; D020910:Ketorolac