Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study

Huseyin Gocergil 1, Mehmet Cesur 2, Elzem Sen 2, Ergun Mendes 1 *
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1 Anesthesiology and Reanimation Department, Kilis State Hospital, Kilis, Turkey
2 Department of Anesthesiology and Reanimation, School of Medicine, Sahinbey Research and Education Center, Gaziantep University, Gaziantep, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 1, pp. 64-68.
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Objective: Modified approaches are emphasized to make the traditional IVRA method more reliable and effective. We aimed to compare two different concentrations used with temporary tourniquet application in addition to the IVRA method for reducing local anesthetics amount in hand and wrist surgeries.
Material and methods: After the approval of Gaziantep University Ethics Committee had been obtained, observation forms of patients with ASA physical score I-II who had undergone elective orthopedic upper extremity surgery were reviewed retrospectively. The patients were divided into two groups according to the concentration of 150 mg of lidocaine in saline. The patients were administered 150 mg lidocaine in 15 ml (Group 15, n:29) and 20 ml (Group 20, n:26) saline. Patients were enrolled into groups in a random and a blind fashion, and after the exclusion criteria were assessed, twenty patients from each group were evaluated. Demographic data, the classification of operation time, the peri-operative follow-up values, the sedoanelgesia consumption needs and the postoperative patient satisfaction scores were compared.
Results: Demographic data were similar in both groups. The tourniquet time was 40.75±14.71 minutes in Group 15 and 38.25±9.77 minutes in Group 20 (p=0.531). Sedation start time was 23.18±9.02 in Group 15 (n=11) and 26.53±6.57 minutes in Group 20 (n=13) (p=0.304). Tourniquet pain time was 46.66±2.88 in group 15 (n=3) and 50.00±7.07 minutes in group 20 (n=2) (p=0.624). No statistically significant difference was found between the all-time classifications, hemodynamic values, peri-operative sedoanalgesia consumptions, and the patient satisfaction scores between the groups (p>0,05). A continuous increase in sedoanalgesic consumption amount​​ with time was observed. None of the patients had signs of local anesthetic toxicity.
Conclusion: We suppose that the plasticity inherent to the IVRA may be optimized by alternative adaptations to be used for decreasing the amount of local anesthetic to safer levels and for reducing the risk of related side effects.


Gocergil H, Cesur M, Sen E, Mendes E. Comparing two different lidocaine concentrations in addition to the tourniquet application to incorporate in the Intravenous Regional Anesthesia (IVRA) Method for reducing the total amount of local anesthetic in hand and wrist surgeries: A randomized cohort study. J CLIN MED KAZ. 2021;18(1):64-8.


  • Bier A. Über einen neuen Weg: Localananästhessie an den Gliedmaassen zu erzeguen. Arc Klin Chir. 1908; 52:842-848.
  • Loser B, Petzoldt M, Loser A, Bacon DR, Goerig M. Intravenous Regional Anesthesia: A Historical Overview and Clinical Review. J Anesth Hist. 2019; 5(3):99-108.
  • Cousins M, Bridenbaugh P. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. 4th ed. Lippincott Williams & Wilkins: a Wolters Kluwer; 2009. 372-382p.
  • Nishiyama T. Supraclavicular block vs. intravenous regional anaesthesia for forearm surgery. Anaesthesiol Intensive Ther. 2019; 51(1):17-20.
  • Arslanian B, Mehrzad R, Kramer T, Kim DC. Forearm Bier block: a new regional anesthetic technique for upper extremity surgery. Ann Plast Surg. 2014; 73(2):156-157.
  • Singh R, Bhagwat A, Bhadoria P, Kohli A. Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries. Minerva Anestesiol. 2010; 76(2):109-114.
  • Karalezli N, Karalezli K, Iltar S, Cimen O, Aydogan N. Results of intravenous regional anaesthesia with distal forearm application. Acta Orthop Belg. 2004; 70(5):401-405.
  • Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications. J Clin Anesth. 2009; 21(8):585-594.
  • Chong AK, Tan DM, Ooi BS, Mahadevan M, Lim AY, Lim BH. Comparison of forearm and conventional Bier's blocks for manipulation and reduction of distal radius fractures. J Hand Surg Eur Vol. 2007; 32(1):57-59.
  • Fletcher SJ, Hulgur MD, Varma S, Lawrence E, Boome RS, Oswal S. Use of a temporary forearm tourniquet for intravenous regional anaesthesia: a randomised controlled trial. Eur J Anaesthesiol. 2011; 28(2):133-136.
  • Song L, Wu C, Liu J, Zuo Y, Volinn E, Yao J. Potential advantages of an additional forearm rubber tourniquet in intravenous regional anesthesia: a randomized clinical trial. J Anesth. 2015; 29(4):551-556.
  • Ulus A, Gurses E, Ozturk I, Serin S. Comparative evaluation of two different volumes of lidocaine in intravenous regional anesthesia. Med Sci Monit. 2013; 19:978-983.
  • Suzuki N, Pitkanen M, Sariola H, Palas T, Rosenberg PH. The effect of plain 0.5% 2-chloroprocaine on venous endothelium after intravenous regional anaesthesia in the rabbit. Acta Anaesthesiol Scand. 1994; 38(7):653-656.
  • Haghighi M, Mardani-Kivi M, Mirbolook A, Tehran SG, Saheli NA, Hashemi-Motlagh K. A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia. Arch Bone Jt Surg. 2018; 6(1):63-70.
  • Heavner JE, Leinonen L, Haasio J, Kytta J, Rosenberg PH. Interaction of lidocaine and hypothermia in Bier blocks in volunteers. Anesth Analg. 1989; 69(1):53-59.
  • Stimpson J, Gill DF, Memarzadeh A, Dunne M, Perry L, Magan A et all. Reducing the Hypertensive Effects of the Prolonged Surgical Tourniquet Using a Dual-Cuff Strategy: A Prospective Randomized Controlled Trial. J Foot Ankle Surg. 2019; 58(6):1177-1186.
  • Chiao FB, Chen J, Lesser JB, Resta-Flarer F, Bennett H. Single-cuff forearm tourniquet in intravenous regional anaesthesia results in less pain and fewer sedation requirements than upper arm tourniquet. Br J Anaesth. 2013; 111(2):271-275.