Intravenous regional anaesthesia

Matt, Corinna M.

doi:10.1016/j.mpaic.2007.01.015

« Previous Next »Anaesthesia & intensive care medicine
Volume 8, Issue 4 , Pages 137-139, April 2007

Intravenous regional anaesthesia

Corinna M Matt, FRCA, is Consultant Anaesthetist at the Luton and Dunstable Hospital. She qualified from Justus-Liebig University, Giessen, Germany. She trained in England at the Eastern Deanery and in Australia at the Royal Darwin Hospital. Her interests include regional anaesthesia and the management of acute pain

Abstract

Intravenous regional anaesthesia (IVRA) was first described almost a century ago by August Bier and has been used for the past 50 years. It is a safe anaesthetic technique for upper or lower distal limb surgery. It utilizes a tourniquet, ideally a double tourniquet, followed by exsanguination of the appropriate limb after insertion of a cannula, through which local anaesthetic is injected. Anaesthesia and analgesia follow rapidly, the tourniquets preventing systemic local anaesthetic toxicity as well as fixing the local anaesthetic to where it is required. The safest local anaesthetic is prilocaine 0.5%. Lidocaine 0.5% can also be used. Several adjuvants have been described to prolong anaesthesia time and reduce tourniquet pain.

Keywords: Bier’s block, distal limb surgery, IVRA, local anaesthetic, tourniquet pain