The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review
Abstract 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 patient...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-018-0550-4 |
| _version_ | 1819056797813571584 |
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| author | Valerie Dekoninck Yasmine Hoydonckx Marc Van de Velde Jean-Paul Ory Jasperina Dubois Luc Jamaer Hassanin Jalil Björn Stessel |
| author_facet | Valerie Dekoninck Yasmine Hoydonckx Marc Van de Velde Jean-Paul Ory Jasperina Dubois Luc Jamaer Hassanin Jalil Björn Stessel |
| author_sort | Valerie Dekoninck |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-21T13:29:08Z |
| format | Article |
| id | doaj.art-ab48627eadef4ffbb9b173e7929ced0a |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-21T13:29:08Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-ab48627eadef4ffbb9b173e7929ced0a2022-12-21T19:02:22ZengBMCBMC Anesthesiology1471-22532018-07-011811810.1186/s12871-018-0550-4The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic reviewValerie Dekoninck0Yasmine Hoydonckx1Marc Van de Velde2Jean-Paul Ory3Jasperina Dubois4Luc Jamaer5Hassanin Jalil6Björn Stessel7Department of Anesthesiology and Pain Medicine Jessa HospitalDepartment of Anesthesiology and Pain Medicine Jessa HospitalDepartment of Cardiovascular Sciences, KU Leuven and Department of Anesthesiology, UZ LeuvenDepartment of Anesthesiology and Pain Medicine Jessa HospitalDepartment of Anesthesiology and Pain Medicine Jessa HospitalDepartment of Anesthesiology and Pain Medicine Jessa HospitalDepartment of Anesthesiology and Pain Medicine Jessa HospitalDepartment of Anesthesiology and Pain Medicine Jessa HospitalAbstract 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.http://link.springer.com/article/10.1186/s12871-018-0550-4Intravenous regional anesthesiaForearm IVRAUpper arm IVRAAnalgesic efficacyBier block |
| spellingShingle | Valerie Dekoninck Yasmine Hoydonckx Marc Van de Velde Jean-Paul Ory Jasperina Dubois Luc Jamaer Hassanin Jalil Björn Stessel The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review BMC Anesthesiology Intravenous regional anesthesia Forearm IVRA Upper arm IVRA Analgesic efficacy Bier block |
| title | The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review |
| title_full | The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review |
| title_fullStr | The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review |
| title_full_unstemmed | The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review |
| title_short | The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review |
| title_sort | analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet a systematic review |
| topic | Intravenous regional anesthesia Forearm IVRA Upper arm IVRA Analgesic efficacy Bier block |
| url | http://link.springer.com/article/10.1186/s12871-018-0550-4 |
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