Journal article
Safety and Efficacy of Forearm Tourniquet Compared to Upper Arm Tourniquet for Local Intravenous Regional Anesthesia in Hand Surgery: A Randomized Clinical Trial
The Iowa orthopaedic journal, Vol.41(1), pp.177-181
2021
PMCID: PMC8259182
PMID: 34552422
Appears in Diamond Open Access
Abstract
Forearm tourniquets may offer decreased doses of anesthetic, shorter procedure times, and less pain compared to upper arm tourniquets. There is limited data comparing the clinical efficacy of forearm Bier blocks to conventional upper arm Bier blocks. The purpose of this study was to assess the effectiveness, complications, duration, cost, and patient satisfaction between forearm and upper arm Bier blocks during surgery.
Sixty-six carpal tunnel release, ganglion excision, or trigger finger procedures were performed. Patients were randomized to 3 groups: upper arm tourniquet for 25 minutes, forearm tourniquet for 25 minutes, or forearm tourniquet with immediate deflation following the procedure (<25 minutes). The efficacy of surgical anesthesia, tourniquet discomfort, and supplementary local anesthetic administration were recorded. Pain was assessed intraoperatively and postoperatively. Patient satisfaction was assessed on the first postoperative day.
No difference was observed between groups with respect to pain, satisfaction, or administration of supplemental medication. The tourniquet time for the group with immediate deflation following procedure was shorter by an average of 9.3 minutes. Total hospital charges were 9.95% cheaper with immediate tourniquet deflation compared to procedures where the tourniquet remained inflated for at least 25 minutes.
The forearm Bier block is a safe, efficient, cost-effective technique for intravenous regional anesthesia during hand surgery, and tourniquet deflation immediately following the procedure (<25 minutes) does not increase incidence of complications. The forearm tourniquet reduces the dose of local anesthetic and therefore risk for systemic toxicity, with similar effectiveness as compared to the upper arm technique.
II.
Details
- Title: Subtitle
- Safety and Efficacy of Forearm Tourniquet Compared to Upper Arm Tourniquet for Local Intravenous Regional Anesthesia in Hand Surgery: A Randomized Clinical Trial
- Creators
- Alexander J Volkmar - University of IowaMolly A Day - University of IowaIgnacio Garcia Fleury - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USAEricka A Lawler - University of IowaMelinda Seering - University of IowaLindsey S Caldwell - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.41(1), pp.177-181
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- PMID
- 34552422
- PMCID
- PMC8259182
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Language
- English
- Date published
- 2021
- Academic Unit
- Orthopedics and Rehabilitation; Anesthesia
- Record Identifier
- 9984295938102771
Metrics
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