INTRAVENOUS REGIONAL ANAESTHESIA FOR SHORT UPPER LIMB SURGERIES IN AN EMERGING TEACHING HOSPITAL

Afolayan Jide Michael*, Popoola Sunday Ogunsuyi, Salawu Adebayo Idris, Kadiri Innih, Ogunlusi Johnson Dare and Olaogun Julius Gbenga

ABSTRACT

Objective: To report the outcome of Intravenous Regional Anaesthesia (IVRA) in patients with upper limb surgeries in a result poor country. Methods: A prospective study of Intravenous Regional Anaesthesia in patients with upper limb surgeries from January 2013 to December 2016 was carried out using two sets of sphygmomanometer cuffs (the ones used to measure blood pressure) in lieu of standard double-lumen pneumatic cuffs. Intravenous access in the uninvolved extremity was established. One percent Lidocaine (3mg/kg) was diluted to 3mg/kg 0.5% Lidocaine solution. Two sets of sphygmomanometer cuffs were placed in the arm of the involved extremity. Small IV cannula was also inserted near the pathological lesion and secured. The affected extremity was elevated and exsanguinated. Proximal cuff was inflated 100mmHg above systolic and then the extremity was lowered. Lidocaine 3mg/kg 0.5% was infused. The infusion needle was removed and the site was taped. The surgery was performed. Patients’ age, sex, weight, ASA status, blood pressure, pain score, intra-operative and postoperative values were documented. Results:. Fifty-eight patients were recruited for the study. Twenty seven patients were male while other patients were female. No incidence of pain intra-operatively. Induction of Bier’s block was successful in all the 58 patients studied. There was a transient incidence of hypotension in one patient. Time to first analgesia was 110 (13.1) min. Post-operatively, there was incidence of dizziness in one patient. Conclusion: The study highlights that the use of two sets of syphgmomanometer cuffs, in lieu of standard doublelumen pneumatic cuffs, is possible during Intravenous Regional Anaesthesia.

Keywords: Regional anaesthesia, pneumatic cuffs, syphgmomanometer, Lidocaine, Prilocaine.