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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Single injection digital block: is a transthecal injection necessary?

M Sonohata1, A Asami, K Ogawa

  • 1Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan. epc9719@yahoo.co.jp

The Journal of Hand Surgery, European Volume
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Summary

Digital block anesthesia techniques were compared in healthy volunteers. Deep transthecal injection confined anesthetic to the sheath but reduced coverage, offering no advantage over traditional or subcutaneous methods for digital anesthesia.

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Area of Science:

  • Anesthesiology
  • Orthopedic Surgery
  • Hand Surgery

Background:

  • Digital block anesthesia is crucial for hand and finger procedures.
  • Evaluating different injection techniques is essential for optimizing anesthetic delivery and efficacy.
  • Traditional transthecal injections may lead to inaccurate anesthetic distribution.

Purpose of the Study:

  • To compare the success and extent of anesthesia achieved by three different digital block injection techniques.
  • To determine the accuracy and distribution of anesthetic agents with each method.
  • To assess the clinical utility of transthecal digital blocks compared to subcutaneous injections.

Main Methods:

  • 15 healthy volunteers participated in the study.
  • Three distinct injection methods for digital block anesthesia were performed: traditional transthecal, deep transthecal single injection, and subcutaneous injection.
  • The success, extent, and duration of anesthesia were evaluated for each technique.

Main Results:

  • Traditional transthecal injections showed inaccurate agent distribution, primarily flowing into the subcutaneous space.
  • Deep transthecal single injection successfully retained the anesthetic agent within the flexor tendon sheath.
  • Subcutaneous and traditional transthecal injections provided similar, satisfactory duration and area of anesthesia.
  • Deep transthecal injection resulted in a significantly smaller anesthetic area compared to the other two methods (P<0.01).

Conclusions:

  • A transthecal digital block does not offer significant advantages over a simple subcutaneous digital block.
  • The deep transthecal technique, while precise in placement, limits the spread of anesthesia.
  • Subcutaneous injection remains a reliable and effective method for achieving adequate digital anesthesia.