Estèbe J P
Service d'anesthésie-réanimation 2, CHRU de Rennes, Hôpital Hôtel-Dieu, France.
Ann Fr Anesth Reanim. 1999 Jun;18(6):663-73. doi: 10.1016/s0750-7658(99)80154-3.
To analyse current data on intravenous regional anaesthesia (IVRA), its benefits and drawbacks.
Articles were obtained from a Medline search using the following search terms: 'intravenous regional anaesthesia', alone or combined with 'local anaesthetic agents', 'toxicity'.
Following articles in English and in French have been selected: main articles, original articles, update and review articles, letters to the editor and recent editorials.
Physiopathological and pharmacological data were extracted for involved mechanisms and means for improving this technique.
IVRA is a reliable and efficient technique with a lower cost than general anaesthesia and well adapted for limb surgery in the ambulatory patient. Depending on the site of the surgical field, the pneumatic tourniquet is set either on the arm, forearm or wrist for the upper limb or thigh, calf or ankle for the lower limb. When set in periphery, less local anaesthetic agent is required. A wide tourniquet requires a lower inflation pressure than a double cuff tourniquet. A single cuff is as efficient as a dual cuff if shape, size and inflating pressure are appropriate. The limb occlusion pressure (LOP) is the minimal pressure required to occlude blood flow. It is assessed with either a pulse oximeter or Doppler for determination of the lowest cuff inflating pressure. The cuff is inflated to 50 mmHg above LOP. Oozing in the surgical field can be decreased by the re-exsanguination technique. Currently, lidocaine is the only local anaesthetic released in France for IVRA. Addition of a muscle relaxant, a NSAID or clonidine allows the dose of local anaesthetic agent to be decreased and improves postoperative analgesia.
分析目前关于静脉区域麻醉（IVRA）的数据及其利弊。
通过以下检索词在Medline数据库中检索文章：“静脉区域麻醉”，单独使用或与“局部麻醉药”“毒性”组合使用。
选取了以下英文和法文文章：主要文章、原创文章、更新和综述文章、给编辑的信以及近期社论。
提取了涉及该技术机制及改进方法的生理病理和药理学数据。
IVRA是一种可靠且有效的技术，成本低于全身麻醉，非常适合门诊患者的肢体手术。根据手术部位，上肢手术时，气动止血带可设置在上臂、前臂或手腕，下肢手术时可设置在大腿、小腿或脚踝。设置在肢体远端时，所需的局部麻醉药较少。宽止血带所需的充气压力低于双袖带止血带。如果形状、尺寸和充气压力合适，单袖带与双袖带的效果相同。肢体阻断压（LOP）是阻断血流所需的最小压力。可使用脉搏血氧仪或多普勒仪评估LOP，以确定最低的袖带充气压力。袖带充气至高于LOP 50 mmHg。通过再驱血技术可减少手术野渗血。目前，利多卡因是法国唯一用于IVRA的局部麻醉药。添加肌肉松弛剂、非甾体抗炎药或可乐定可减少局部麻醉药的用量并改善术后镇痛效果。
