Intra-arterial versus intravenous regional analgesia for hand surgery

Twenty-six adult patients participated in this study of intra-arterial and intravenous regional analgesia. The radial or the brachial artery was cannulated in patients randomised to receive intra-arterial regional analgesia and a hand vein was cannulated in patients randomised to receive intravenous regional analgesia, with a 22-G cannula. A double cuffed tourniquet and Esmarch's bandage were used. Lignocaine 0.5%, (1.5 mg.kg-1 intra-arterially, and 3.0 mg.kg-1 intravenously) was injected over 3 min. There were two failures (one in each group). Intra-arterial injection of lignocaine was more painful than intravenous injection. Onset and offset of analgesia, surgical and tourniquet pain scores, motor blockade, and bruising after cannulations were similar. Surgical conditions were good in all patients having intra-arterial regional analgesia, fair and poor in five having intravenous regional analgesia (ns). Three of the intravenous regional analgesia patients had transient adverse affects after tourniquet release (ns). No permanent sequelae of cannulations were observed. It is concluded that intra-arterial regional analgesia with lignocaine 0.5%, 1.5 mg.kg-1 has similar onset, offset, quality, failure rate and patient acceptance, as intravenous regional analgesia with lignocaine 0.5%, 3.0 mg.kg-1.