[Intravenous regional anesthesia of the arm]

Intravenous regional anesthesia is a well established technique since the start of this century. It is easy to perform, with rapid onset of analgesia and safe to practice, when proper patient monitoring (ECG, intermittent blood pressure monitoring, oxygen delivery by nasal insufflation) is established and a local anesthetic solution with low systemic toxicity (e.g. prilocaine) is used. When choosing this technique of regional anesthesia it is an important condition, that the operative procedure has to be finished before the tourniquet of the upper arm is released. Immediately after this cuff-release and recirculation of the arm analgesia will diminish. When using prilocaine or mepivacaine as local anesthetic drug a complete surgical analgesia of 30 up to 45 min can be achieved. Long-acting local anesthetics should not be used because of their increased systemic toxicity under the aspect of drug wash-out at the end of the procedure or in terms of inadvertent cuff release. The site of action of intravenous regional anesthesia has been controversial, since adequate clinical investigations with contrast media and radio isotopes proved, that the principal site of action is at the peripheral nerve endings.