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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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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Clinical Effects of Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment

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[Triple nerve block for ambulatory knee arthroscopy].

P Cuvillon¹, E Nouvellon, P Marchand

¹Pôle anesthésie réanimation douleur urgence, groupe hôpital universitaire Carémeau, place du Professeur-Debré, Nîmes, France. philippe.cuvillon@wanadoo.fr

Annales Francaises D'Anesthesie Et De Reanimation

|September 22, 2010

Summary

The triple nerve block is effective for outpatient knee arthroscopy, ensuring reliable conditions for patients and surgeons. However, a 10% block failure rate necessitates supplemental anesthesia in some cases.

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Area of Science:

Anesthesiology
Orthopedic Surgery

Background:

Outpatient knee arthroscopy requires effective anesthesia.
Evaluating the triple nerve block (femoral, obturator, sciatic) is crucial for these procedures.

Purpose of the Study:

To assess the intraoperative and postoperative outcomes of the triple nerve block technique.
To determine the safety and efficacy of this regional anesthesia approach for ambulatory knee surgeries.

Main Methods:

115 patients received a triple nerve block using lidocaine or mepivacaine with nerve stimulation.
Data collected included block onset, failure rates, need for supplemental general anesthesia (GA), pain scores, and side effects.
Patient and surgeon satisfaction, as well as postoperative recovery and discharge criteria, were evaluated.

Main Results:

A 10% block failure rate was observed, requiring supplemental GA in 12% of patients.
Intraoperative surgeon satisfaction was high (90%). Postoperative pain scores were low, and discharge occurred within 15-60 minutes.
Minor side effects like PONV and paresthesia were reported in a small percentage of patients, with 91% willing to have the same anesthesia again.

Conclusions:

The triple nerve block offers reliable intraoperative conditions for outpatient knee arthroscopy.
Block failure remains a primary reason for supplemental anesthesia.
Optimizing block onset time, potentially with a preoperative room, could enhance surgical turnover.