Intravenous Regional Anesthesia in Hand Surgery

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Abstract
We have found intravenous regional anesthesia, by the method of expressing the blood, applying a temporary tourniquet, injecting the lidocaine, then placing the second tourniquet on an anesthetized portion of the arm and removing the first tourniquet, to be a very simple and effective way to achieve anesthesia in operations on the hand. The quantities of lidocaine used seem to be well below the toxic amounts by several multiples (this would obtain if the tourniquet should fail). The quantities of lidocaine recovered in the systemic circulation were minute. We did not observe any clear-cut toxic reactions in thirty-six patients. Nerve-conduction studies tended to show that no motor impulses could be transmitted by the median nerve and that anoxia did not seem to play a major role in the production of the anesthesia up to twenty minutes. The usual precautions of availability of oxygen and appropriate drugs should be observed, as is customary when using local anesthetic agents, and the surgeon must be mindful of his selection of cases in regard to necessary operating time, since anesthesia depends on the continuous and uninterrupted presence of the tourniquet.

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