Schürg R, Biscoping J, Bachmann-M B, Hempelmann G
Abteilung Anaesthesiologie, Operative Intensivmedizin, Klinikum der Justus-Liebig-Universität Giessen.
Reg Anaesth. 1990 Jul;13(5):118-21.
Intravenous regional anesthesia (IVRA) of the foot is a rarely used but alternative method to other regional techniques and general anesthesia, especially when operating on the distal portion of the lower limb. The present report describes our method and experience with this type of anesthesia in approximately 500 patients, including pharmacokinetic and -dynamic aspects. MATERIALS AND METHODS. Pharmacological studies were performed in 17 orthopedic outpatients undergoing operations on the foot following an IVRA technique with prilocaine. A plastic cannula was inserted into a peripheral vein of the forefoot and a pneumatic tourniquet (350 mm Hg) applied proximally and close to the malleoli after achieving exsanguination with an Esmarch bandage. If there was no sufficient analgesia (pinprick testing) 5 min after injection of 200 mg prilocaine, IVRA was supplemented with another 100 mg of local anesthetic. Peripheral venous blood samples were collected at short intervals for up to 2 h before and after cuff release to determine total plasma concentrations of prilocaine (HPLC) and the degree of methemoglobinemia (CO-Oximeter). RESULTS. Administration of 200-300 mg prilocaine resulted in complete analgesia in 15 of 17 cases that was sufficient for operations lasting up to 85 min. The tourniquet was tolerated for up to 105 min without any complaints. Plasma concentrations after 200 (n = 12) and 300 mg prilocaine (n = 3) peaked between 10 and 20 min after cuff release, respectively, with maximum levels of 0.96 micrograms/ml (means = 0.56 micrograms/ml) and 1.45 micrograms/ml. The extent of methemoglobin formation was low (maximum 3.8% of total hemoglobin). DISCUSSION. In addition to conventional anesthetic techniques, IVRA deserves a firm place in modern anesthesiological practice and should be used more widely. In order to avoid systemic toxic reactions, the use of prilocaine is recommended. Prolocaine plasma concentrations and methemoglobin formation were both far below toxic levels. Failure of IVRA was probably caused by premature outflow of the local anesthetic solution, as shown by the course of prilocaine plasma concentrations and methemoglobinemia.
足部静脉区域麻醉（IVRA）是一种很少使用但可替代其他区域麻醉技术和全身麻醉的方法，尤其适用于下肢远端手术。本报告描述了我们在大约500例患者中使用这种麻醉方法的操作及经验，包括药代动力学和药效学方面。材料与方法。对17例接受足部手术的骨科门诊患者采用丙胺卡因进行IVRA技术，进行了药理学研究。在前足的外周静脉插入一根塑料套管，在用Esmarch绷带驱血后，在踝关节近端且靠近踝关节处应用充气止血带（350mmHg）。如果注射200mg丙胺卡因5分钟后镇痛效果不佳（针刺测试），则再补充100mg局部麻醉药进行IVRA。在止血带松开前后的2小时内，每隔一段时间采集外周静脉血样，以测定丙胺卡因的血浆总浓度（高效液相色谱法）和高铁血红蛋白血症的程度（一氧化碳血氧仪）。结果。给予200 - 300mg丙胺卡因后，17例中有15例获得了完全镇痛效果，足以进行长达85分钟的手术。止血带耐受时间长达105分钟，无任何不适主诉。分别在200mg（n = 12）和300mg丙胺卡因（n = 3）给药后，止血带松开后10至20分钟血浆浓度达到峰值，最高水平分别为0.96μg/ml（均值 = 0.56μg/ml）和1.45μg/ml。高铁血红蛋白形成程度较低（最高占总血红蛋白的3.8%）。讨论。除了传统的麻醉技术外，IVRA在现代麻醉实践中应占有一席之地，并且应更广泛地应用。为避免全身毒性反应，建议使用丙胺卡因。丙胺卡因血浆浓度和高铁血红蛋白形成均远低于中毒水平。IVRA失败可能是由于局部麻醉药溶液过早流出所致，丙胺卡因血浆浓度和高铁血红蛋白血症的变化过程表明了这一点。
