Davies J A, Hall I D, Wilkey A D, Smith J E, Walford A J, Kale V R
Anaesthesia. 1984 May;39(5):416-21. doi: 10.1111/j.1365-2044.1984.tb07307.x.
Two cases are described in which congestion of the arm occurred during intravenous regional analgesia. One case exhibited signs of serious local anaesthetic toxicity, while a significant plasma bupivacaine level was demonstrated in the other. In a study in a volunteer, leakage of contrast medium past the cuff was demonstrated radiologically only when congestion of the arm was produced. The Hoyle double cuff apparatus has narrow cuffs producing less tissue compression than a standard blood pressure cuff inflated to the same pressure. It may sometimes not occlude the brachial artery when inflated to a pressure based on the systolic arterial pressure measured with a standard cuff and congestion of the arm may then result. Increases in arterial blood pressure occurring during the procedure can also lead to congestion of the arm. Congestion may increase the risk of local anaesthetic agent leaking past the tourniquet into the systemic circulation. Recommendations are made about the choice of cuff gauge pressure and the prevention of arm congestion occurring during intravenous regional analgesia.
本文描述了两例在静脉区域镇痛期间出现手臂充血的病例。一例表现出严重的局部麻醉药毒性迹象，而另一例则显示出布比卡因血浆水平显著升高。在一项针对志愿者的研究中，只有当手臂出现充血时，通过放射学检查才证实造影剂漏过袖带。霍伊尔双袖带装置的袖带较窄，与充气至相同压力的标准血压袖带相比，对组织的压迫较小。当按照用标准袖带测量的收缩压充气时，它有时可能无法阻断肱动脉，进而可能导致手臂充血。手术过程中动脉血压升高也可能导致手臂充血。充血可能会增加局部麻醉药漏过止血带进入体循环的风险。文中针对袖带规格压力的选择以及预防静脉区域镇痛期间手臂充血提出了建议。
