Kim D D, Shuman C, Sadr B
Howard University Hospital, Washington, DC.
Orthopedics. 1993 Oct;16(10):1109-13. doi: 10.3928/0147-7447-19931001-05.
A prospective study was undertaken in 39 patients undergoing 48 foot and ankle procedures using intravenous regional anesthesia (IVRA). IVRA was administered using 35 cc of 0.33% or 0.5% lidocaine. Single tourniquets inflated to 250 mm Hg were used at the ankle level. No supplemental analgesia or sedation was used. Those requiring supplemental local anesthetic infiltration were defined as IVRA failures. Thirty-one of the 39 patients (79.5%) tolerated the procedures with little or no discomfort, and 8 (20.5%) required additional local infiltration with 1% lidocaine. All 39 patients completed the procedures at the outpatient surgical unit without requiring conversion to other forms of anesthesia. Patchy non-anesthetic areas were noted in 14 patients (36.8%). In 7 patients, because the non-anesthetic areas were excluded from the operative fields, the procedures were completed without discomfort. However, in 8 patients where the non-anesthetic areas were directly involved in the operative fields, supplemental local anesthesia was required. Only 1 of the 39 patients complained of tourniquet pain. IVRA compared favorably with other methods of regional anesthesia in the lower extremity with respect to ease of technique, speed of onset, safety, and patient acceptance. However, it appears that it is less reliable than IVRA in the upper extremity. The reasons for this difference will require further investigation.
对39例接受48次足踝手术的患者进行了一项前瞻性研究，采用静脉区域麻醉（IVRA）。IVRA使用35毫升0.33%或0.5%的利多卡因进行给药。在踝关节水平使用单个止血带，充气至250毫米汞柱。未使用补充镇痛或镇静药物。那些需要补充局部麻醉剂浸润的患者被定义为IVRA失败。39例患者中有31例（79.5%）在手术过程中几乎没有不适或完全没有不适，8例（20.5%）需要额外注射1%的利多卡因进行局部浸润。所有39例患者均在门诊手术单元完成手术，无需转换为其他麻醉方式。14例患者（36.8%）出现局部非麻醉区域。7例患者由于非麻醉区域被排除在手术区域之外，手术在无不适的情况下完成。然而，在8例非麻醉区域直接涉及手术区域的患者中，需要补充局部麻醉。39例患者中只有1例抱怨止血带疼痛。在技术简便性、起效速度、安全性和患者接受度方面，IVRA与下肢其他区域麻醉方法相比具有优势。然而，在上肢，IVRA似乎不如在下肢可靠。这种差异的原因需要进一步研究。
