The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review
Autor: | Luc Jamaer, Björn Stessel, Valerie Dekoninck, Jasperina Dubois, Yasmine Hoydonckx, Marc Van de Velde, Jean-Paul Ory, Hassanin Jalil |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Forearm IVRA
medicine.medical_treatment HAND SURGERY law.invention 0302 clinical medicine Randomized controlled trial Anesthesiology 030202 anesthesiology law Anesthetics Local Pain Measurement 030222 orthopedics Tourniquet Local anesthetic PAIN Forearm medicine.anatomical_structure Anesthesia Intravenous regional anesthesia Anesthesia Intravenous Arm TRIAL medicine.symptom Upper arm IVRA Life Sciences & Biomedicine medicine.drug Research Article medicine.medical_specialty medicine.drug_class Sedation Bier block lcsh:RD78.3-87.3 03 medical and health sciences LEAKAGE medicine Humans TOLERANCE Science & Technology 0.5-PERCENT LIDOCAINE Ropivacaine business.industry Analgesic efficacy Tourniquets PREVENTION Anesthesiology and Pain Medicine ROPIVACAINE lcsh:Anesthesiology business |
Zdroj: | BMC Anesthesiology BMC Anesthesiology, Vol 18, Iss 1, Pp 1-8 (2018) |
ISSN: | 1471-2253 |
Popis: | BACKGROUND: The main objective of this review is to perform a systematic review and meta-analysis of the existing evidence related to the analgesic efficacy with the use of conventional, upper arm intravenous regional anesthesia (IVRA) as compared to a modified, forearm IVRA in adult patients undergoing procedures on the distal upper extremity. METHODS: MEDLINE, EMBASE and CENTRAL (Cochrane) databases were searched for randomized controlled trials published in English, French, Dutch, German or Spanish language. Primary outcomes of interest including description of quality level of anesthesia and onset of sensory block were assessed for this review. Dosage of the local anesthetic, local anesthetic toxicity and need for sedation due to tourniquet pain were considered as secondary outcomes. RESULTS: Our literature search yielded 3 papers for qualitative synthesis. Four other articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA. Forearm IVRA was found to be as efficient as upper arm IVRA (RR = 0.98 [0.93, 1.05], P = 0.78), but comes with the advantage of a lower need for sedation due to less tourniquet pain. CONCLUSION: Our results demonstrate that forearm IVRA is as effective in providing a surgical block as compared to a conventional upper arm IVRA, even with a reduced, non-toxic dosage of local anesthetic. No severe complications were associated with the use of a forearm IVRA. Other benefits of the modified technique include a faster onset of sensory block, better tourniquet tolerance and a dryer surgical field. REGISTRATION OF THE SYSTEMATIC REVIEW: A review protocol was published in the PROSPERO register in November 2015 with registration number CRD42015029536 . ispartof: BMC Anesthesiology vol:18 issue:1 ispartof: location:England status: published |
Databáze: | OpenAIRE |
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