scholarly journals A Comparative Study of the Anesthetic Efficacy, Post Tourniquet Release Analgesia and Side Effects of Ropivacaine 0.2% & Lignocaine 0.5% in Intravenous Regional Anesthesia for Hand Surgeries

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
A Gowri Shankar ◽  
Keyword(s):  
Side Effects ◽  
Comparative Study ◽  
Regional Anesthesia ◽  
Intravenous Regional Anesthesia ◽  
Tourniquet Release

Bilateral Intravenous Regional Anesthesia

2003 ◽  
Vol 98 (6) ◽  
pp. 1427-1430 ◽  
Author(s):  
Maximilian W.B. Hartmannsgruber ◽  
Sabine Plessmann ◽  
Peter G. Atanassoff
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effects ◽  
Regional Anesthesia ◽  
Normal Saline ◽  
Drug Combinations ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Study Session ◽  
Tourniquet Release

Background Ketorolac, when added to lidocaine, has been shown to reduce early tourniquet pain during intravenous regional anesthesia (i.v.RA) in patients. Although the effectiveness of ropivacaine 0.2% for i.v.RA is equal to that of lidocaine 0.5% but significantly reduces central nervous system side effects after release of the tourniquet, it provides no advantage with regard to tourniquet tolerance times. Simultaneous bilateral i.v.RA with ropivacaine 0.2% was used to test the hypothesis that ketorolac modifies tourniquet tolerance and to test whether drug combinations can be evaluated in one study session. Methods Ten healthy, unsedated volunteers received 30 ml of ropivacaine 0.2% in each upper arm with 2 ml of normal saline in one arm and 30 mg of ketorolac in the contralateral arm for i.v.RA. Both proximal tourniquets remained inflated for 30 min, followed by inflation of the distal tourniquets and release of the proximal ones. Verbal numeric scores for tourniquet pain were recorded for both extremities. Central nervous system side effects were graded after release of each distal tourniquet. Results There was no difference between the two upper extremities with regard to surgical anesthesia and tourniquet tolerance. Total tourniquet tolerance was a median of 58.5 min (range, 45-90 min) and 60.5 min (39-79 min) in the normal saline and ketorolac groups, respectively. After release of the distal tourniquets, 5 of 10 volunteers experienced mild dizziness. Conclusions The addition of ketorolac to ropivacaine does not improve tourniquet tolerance. Minimal central nervous system side effects after tourniquet release suggest that a total of 60 ml ropivacaine 0.2% for bilateral i.v.RA is a useful model for comparison of i.v.RA drug combinations.

Levobupivacaine 0.125% and Lidocaine 0.5% for Intravenous Regional Anesthesia in Volunteers

2002 ◽  
Vol 97 (2) ◽  
pp. 325-328 ◽  
Author(s):  
Peter G. Atanassoff ◽  
Rima Aouad ◽  
Maximilian W.B. Hartmannsgruber ◽  
Thomas Halaszynski
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effects ◽  
Regional Anesthesia ◽  
Motor Function ◽  
Local Anesthetic ◽  
Cardiac Events ◽  
Binding Effect ◽  
Cardiac Side Effects ◽  
Intravenous Regional Anesthesia

Background Levobupivacaine, a long acting, amino-amide, local anesthetic, may offer advantages over lidocaine for intravenous regional anesthesia (IVRA). The objective of this investigation was to compare levobupivacaine to lidocaine for IVRA. Methods After institutional review board approval and informed consent, eight unpremedicated male American Society of Anesthesiologists (ASA) I-II volunteers received 40 ml of levobupivacaine 0.125% or lidocaine 0.5% for IVRA on separate days. Onset and regression of sensory anesthesia by pinprick, transcutaneous electrical stimulation (TES), and of motor function were tested before, during, and after release of the tourniquet. Central nervous system and cardiac side effects were evaluated after local anesthetic administration and tourniquet release. The tourniquet remained inflated for 30-45 min. Results Intravenous regional anesthesia with either agent provided surgical anesthesia. Sensory anesthesia to pinprick (lateral antebrachial cutaneous nerve) was faster with lidocaine at median 1.5 min. versus 12.5 min with levobupivacaine. Loss of sensation to TES occurred at median 22.5 and 27.5 min for lidocaine and levobupivacaine, respectively. Loss of motor function occurred earlier after lidocaine administration. After release of the tourniquet, return of sensation to TES, pinprick (ulnar nerve), and return of motor function occurred later with levobupivacaine at median 25, 15, and 21.25 versus 10, 4.5, and 10 min with lidocaine. Central nervous system side effects were absent in volunteers given levobupivacaine, but five of eight volunteers given lidocaine experienced mild side effects. No cardiac events were noted. Conclusions Levobupivacaine 0.125% may be an alternative to lidocaine 0.5% for IVRA. Longer lasting analgesia after release of the tourniquet may be caused by a more profound and prolonged tissue binding effect of levobupivacaine.

scholarly journals Bier's block

2015 ◽  
Vol 3 (1) ◽  
pp. 23
Author(s):  
Kalpana Kharbuja ◽  
Mahesh Sharma ◽  
Nil Raj Sharma
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Regional Anesthesia ◽  
Rapid Onset ◽  
Technical Errors ◽  
Intravenous Regional Anesthesia ◽  
Safety Considerations ◽  
Plexus Block ◽  
Time Limitations ◽  
Toxic Reactions

Introduction: Intravenous Regional Anesthesia (IVRA) has been first described in 1908 by the German surgeon August KG Bier. Although the technique was convenient to perform and effective in giving surgical anesthesia, the recent plexus block techniques have largely replaced the "Bier’s block" instantly because of time limitations and safety considerations of IVRA. Throughout the years, modifications in procedure and new pharmacologic adjuvants have shown to prevent toxic reactions to anesthetics and mitigate limitations of IVRA, still IVRA can be preferred as choice of anesthesia for short procedures. Case Report: We present a case of 86 yr old male who was operated for radius fracture after a fall injury under Bier's Block or IVRA technique. Conclusion: IVRA can be the choice ofanesthesia for short procedures because of rapid onset of anesthesia, easy administration and cheaper cost with special considerations on its side effects, complications which can be the outcome of technical errors.

Intravenous Regional Anesthesia

2010 ◽  
pp. 317-322
Author(s):  
Edward D. Frie
Keyword(s):  
Side Effects ◽  
Regional Anesthesia ◽  
Intravenous Injection ◽  
Local Anesthetic ◽  
Insertion Site ◽  
Needle Insertion ◽  
Clinical Applications ◽  
Small Vessels ◽  
Intravenous Regional Anesthesia ◽  
Minor Surgery

The intravenous injection of local anesthetic into an exsanguinated limb provides anesthesia by diffusion of the drug to peripheral nerves supplied by small vessels. Intravenous regional anesthesia is most commonly used for procedures on the hand, wrist, and digits; however, it may also be effective for minor surgery on the foot and ankle. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications.

Comparison of Ropivacaine and Lidocaine for Intravenous Regional Anesthesia in Volunteers

1999 ◽  
Vol 90 (6) ◽  
pp. 1602-1608. ◽  
Author(s):  
Vincent W. S. Chan ◽  
Mitchell J. Weisbrod ◽  
Zsuzsanna Kaszas ◽  
Camelia Dragomir
Keyword(s):  
Regional Anesthesia ◽  
Electric Stimulation ◽  
Motor Block ◽  
Muscle Power ◽  
Venous Blood ◽  
High Dose ◽  
Partial Recovery ◽  
Lidocaine Group ◽  
Intravenous Regional Anesthesia ◽  
Tourniquet Release

Background Ropivacaine may be useful for intravenous regional anesthesia, but its anesthetic effectiveness and toxicity have not been evaluated. Methods Two doses of ropivacaine (1.2 and 1.8 mg/kg) and one dose of lidocaine (3 mg/kg) were compared for intravenous regional anesthesia in 15 volunteers. An arm tourniquet was inflated for 30 min after injection and then deflated in two cycles. Sensory block was measured by response to touch, cold, pinprick, and transcutaneous electric stimulation, and motor function was measured by hand grip strength and muscle power. Median, ulnar, radial, and musculocutaneous nerve functions were tested before local anesthetic injection and then at 5-min intervals until blocks resolved. The plasma ropivacaine and lidocaine concentrations were determined from arterial and venous blood samples drawn from the unanesthetized arm. Results Sensory and motor blocks were complete within 25 min and 30 min, respectively, in all three treatment groups. However, recovery of sensory and motor block after tourniquet release was slowest in the high-dose ropivacaine group. Anesthesia to pinprick and transcutaneous electric stimulation was sustained in all the volunteers in the high-dose ropivacaine group for 55 min and 85 min, respectively, whereas complete recovery was observed in the lidocaine group (P = 0.008) and partial recovery in the low-dose ropivacaine group (P < 0.05) during the same period. Motor block also was sustained in the high-dose ropivacaine group for 70 min, which was significantly longer than in the lidocaine group (P < 0.05). All volunteers (five of five) given lidocaine and one volunteer given high-dose ropivacaine reported light-headedness and hearing disturbance during tourniquet release when the arterial plasma lidocaine and ropivacaine concentrations were 4.7+/-2.1 microg/ml (mean) and 2.7 micro/ml, respectively. Conclusion Compared with lidocaine, intravenous regional anesthesia with ropivacaine appears to be comparable but has longer-lasting residual anesthesia.

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