Subcutaneous ring anaesthesia in the prevention of tourniquet pain in hand surgery

A simple method for achieving satisfactory regional anaesthesia for a wide range of hand surgery is presented. It entails separate attention to the two aims of regional anaesthesia, namely analgesia of the tourniquet and of the operative site. This study of 149 patients indicated that (a) subcutaneous ring anaesthesia produced excellent tourniquet analgesia, both in the forearm as well as the upper arm; (b) a tourniquet applied to the forearm provided excellent regional ischaemia in 98% of our cases, contrary to what has been previously accepted. The advantages of this method are its safety and simplicity even for the relatively untrained surgeon. It also obviates the need for brachial plexus blocks, intravenous regional or general anaesthesia with all their drawbacks.