Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Minerva Anestesiol. 2010 Feb;76(2):109-14. Epub 2009 Dec 23.
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.
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.
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.
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.
局部麻醉中毒仍然是静脉局部麻醉（IVRA）技术最可怕的并发症之一。它是由于大量局部麻醉剂（LA）突然释放到体循环中引起的。这种释放可能发生在手术过程中止血带意外放气时，或者在手术结束时故意放气以终止麻醉时。前臂止血带 IVRA 技术可能比传统的上臂止血带 IVRA 技术具有明显的优势。使用前臂止血带可以将局部麻醉剂的剂量降低到使用上臂止血带所需剂量的近一半，并且据报道前臂止血带的止血带疼痛发生率较低。在这项研究中，作者评估了使用前臂或上臂止血带给予利多卡因加酮咯酸的 IVRA 的临床疗效。
使用 0.5%利多卡因 3mg/kg 和酮咯酸 0.3mg/kg 建立上臂 IVRA。使用 0.5%利多卡因 1.5mg/kg 和酮咯酸 0.15mg/kg 建立前臂 IVRA。记录和评估手术麻醉质量、感觉阻滞的起效时间、持续时间、术后手术疼痛和镇痛药的使用。还记录了局部麻醉毒性和止血带引起的局部并发症的发生率。
接受上臂止血带 IVRA 的 20/20 例患者和接受前臂止血带 IVRA 的 19/20 例患者的手术麻醉均被评估为优秀或良好（0/1 级）（P=1.00）。两组的感觉阻滞起效和消退时间相似。两组术后 30 分钟和 60 分钟的 VAS 评分无统计学差异，两组术后 24 小时内的镇痛药物使用也无统计学差异。
总之，前臂 IVRA 可提供有效的围手术期麻醉和镇痛。该技术在使用利多卡因和酮咯酸剂量减半的情况下，产生与上臂 IVRA 相似的临床效果。
