Intravenous regional anesthesia: new approaches to an old technique.

The pace of modern surgical procedures demands a fast and effective regional anesthesia technique. Intravenous regional anesthesia (IVRA) is such a technique. Traditionally, IVRA has been limited by tourniquet pain, inability to provide postoperative analgesia, and lack of a bloodless field for microsurgical repairs. Current research indicates that these limitations can be significantly improved with alteration of the block solution or alteration of the exsanguination technique. Additions to the local anesthetic such as meperidine, ketorolac, and clonidine have been shown to increase tourniquet tolerance and significantly improve postoperative analgesia. Additionally, when a bloodless field is required for microvascular surgery or nerve repairs, a re-exsanguination technique can be used. Advances in IVRA have made this technique an excellent choice for cases involving the hand, forearm, foot, and lower leg cases that least 60 minutes or less.