Supraclavicular block vs. intravenous regional anaesthesia for forearm surgery

Background
The purpose of this study was to compare the analgesic effect during and after surgery between intravenous regional anaesthesia (IVRA) and the supraclavicular block in forearm surgery.

Methods
Eighty patients aged 30 to 70 years qualified for forearm surgery were divided into a supraclavicular group and an IVRA group. A supraclavicular block was performed with 1% lidocaine at a dose of 20 mL. After anaesthesia was obtained, a single tourniquet was used at a pressure of 200 mm Hg. For the patients in the IVRA group, an intravenous catheter was first inserted in the dorsum of the hand marked for surgery, followed by the placement of a double tourniquet with an elastic bandage wound around it. Once the proximal tourniquet was inflated to a pressure of 200 mm Hg, 1% lidocaine at a dose of 20 mL was injected. When anaesthesia had not been obtained within 30 minutes, the block was judged to have been failure, and general anaesthesia was administered. The onset time of analgesia, to time up to the first sensation of tourniquet pain, and the duration of postoperative analgesia were measured. When patients felt pain at a surgical site during surgery, 50 μg of fentanyl was administered. Any side effects were also checked

Results
The onset time, the duration of postoperative analgesia, and the time up to the sensation of tourniquet pain were significantly shorter in the IRVA group. Other features of the IRVA group were that the number of patients with tourniquet pain was significantly larger and the number of patients with additional fentanyl was significantly smaller. No patients showed any side effects

Conclusion
Although IVRA had a shorter onset time and needed less additional anaesthetic during surgery, it induced more tourniquet pain and had a shorter duration of postoperative analgesia than the supraclavicular block in forearm surgery.