Improved intravenous regional anesthesia for surgery of the hand, wrist, and forearm. The second wrap technique

In 330 consecutive anesthetics administered over a period of 24 months, an improved method of upper extremity intravenous regional anesthesia, entitled "the second wrap technique," included wrapping the extremity a second time with a Martin rubber bandage after the extremity was prepared and draped. In addition, a Penrose drain tourniquet often was applied during injection of the 0.5% lidocaine. No complications occurred. The technique provides a nearly bloodless operative field, improves the anesthesia, diminishes tourniquet pain, lessens the contraindications, and requires no premedication. The only contraindications are allergy to lidocaine, infection, operating time over 2 hours, and severe hypertension.