title: Simple Arm Tourniquet as an Adjunct to Double-Cuff Tourniquet in Intravenous Regional Anesthesia.
abstract: BACKGROUND
  Intravenous Regional Anesthesia (IVRA) is a well-known technique for producing analgesia during surgical procedures in the extremities. However, the rapid onset of pain following the deflation of a double-cuff tourniquet during IVRA is a serious disadvantage, leading patient suffering.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the clinical effectiveness of a pneumatic arm tourniquet applied 2 cm above the double-cuff tourniquet in controlling the pain that occurs after its deflation.
  
  
  METHODS
  Twenty patients undergoing outpatient hand surgery were operated on under IVRA, using 40 - 50 mL of a solution containing 3 mg/kg of lignocaine. A simple pneumatic tourniquet was applied proximal to the double-cuff tourniquet, 3 min before its deflation, while the procedure was being conducted. The severity of pain on the basis of the Numerical Rating Scale (NRS) was assessed throughout the operation, and continued until an hour after the double-cuff tourniquet was removed.
  
  
  RESULTS
  The mean operation time after the deflation of the double-cuff tourniquet was 20.12 ± 6.1 minutes. Moreover, the mean NRS for the post-deflation time was insignificant (NRS = 2), and only one patient during first 20 minutes received opioids.
  
  
  CONCLUSIONS
  This study showed that a pneumatic arm tourniquet as an adjunct to IVRA provides acceptable analgesia following the deflation of the double- cuff tourniquet for relieving surgical pain.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Motahari Medical Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Jafarian
authors.affiliation: Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Farnad
authors.initials: F
authors.lastname: Imani
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ali-Asghar Paediatric Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Salehi
authors.affiliation: Department of Orthopaedic, Shafa-Yahyaian Orthpaedic Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Najd Mazaher
authors.affiliation: Department of Traditional Medicine, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Moini
keywords: Analgesia; Double-cuff Tourniquet; Intravenous Regional Anesthesia (IVRA); Lignocaine; Numerical Rating Scale (NRS); Pneumatic Arm Tourniquet