Sequential bilateral upper extremity intravenous regional anesthesia with chloroprocaine

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Surgical Procedures

Background:

• Carpal tunnel syndrome is a common condition requiring surgical intervention.
• Intravenous regional anesthesia (IVRA) is a technique used for limb surgeries.
• Bilateral procedures present unique anesthetic challenges.

Observation:

• A case report details the use of sequential bilateral upper extremity IVRA with 2-chloroprocaine for bilateral endoscopic carpal tunnel decompression.
• A 49-year-old female underwent outpatient bilateral carpal tunnel release.
• 0.5% 2-chloroprocaine 30 mL per arm was administered via a double upper arm tourniquet.

Findings:

• Sequential bilateral IVRA with 2-chloroprocaine was effective for this short-duration bilateral upper extremity surgery.
• The patient experienced mild limb twitching post-tourniquet deflation, which resolved with midazolam.
• The patient recovered rapidly and was discharged uneventfully.

Implications:

• This case suggests that sequential bilateral IVRA with 2-chloroprocaine is a viable anesthetic option for bilateral carpal tunnel decompression.
• The findings support the use of this technique for other short-duration upper extremity surgeries.
• Reviewing recommendations to minimize local anesthetic toxicity is crucial for patient safety.