الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
Bier block, or IVRA, is a method of anesthesia for upper extremity
surgeries. IVRA was first described by August Bier in 1908, and after a period
of latency, it began to gain widespread use after Holmes reemphasized its use
in 1963. Bier blocks are technically easy to perform, and the rates for
successful anesthesia approach 98%. Furthermore, when compared with
brachial plexus blocks for outpatient hand and upper extremity surgery, IVRA
may realize lower costs and faster post-anesthesia recovery.
If the local anesthetic gains access to a patient’s systemic circulation,
the central nervous system (CNS) and cardiovascular system can be affected.
The CNS is usually affected first, with symptoms including dizziness, tinnitus,
perioral paresthesia, and seizures. Anesthetic-induced toxicity of the
cardiovascular system may manifest as hypotension, bradycardia,
arrhythmias, or cardiac arrest.
This prospective cohort, controlled, single-blinded, randomized study
enrolled 80 trauma patients scheduled for both elective and emergency Hand
and Forearm surgery who were further divided into four groups:
• group one (lidocaine or control LE) Early deflation.
• group two (lidocaine, ketorolac LKE) Early deflation.
• group three (lidocaine or control LL) Late deflation.
• group four (lidocaine, ketorolac LKL) Late deflation.
Summary of our results:
• There was no significant difference in LAST risk between early and late
deflation of distal tourniquet in IVRA.Summary
109
• Pain evaluation intraoperative by VAS was significantly higher at 5 min
at group one than group two (P value =0.002) with no significant
difference between group four and group three. and was insignificantly
different at baseline at 10, 20, 30 min, among the studied groups. At 40
min, VAS was significantly higher in group one than group two, three
and four (P value <0.05) with no significant difference among groups
two, three and four. At 50 min, VAS was significantly higher in group
three than four (P value <0.001) with no significant difference among
groups one, two and three. At 60 min, VAS was insignificantly different
at baseline among the studied groups. These results are compatible with
patient’s pain score.
• Postoperative VAS was significantly different at 1, 2, 4, 12 and 24 h and
was insignificantly different at 6 h among the studied groups. At 1, 2
and 4 h, VAS was significantly higher in group one than both group two
and four (P value <0.001) with no significant difference between groups
one and two and was significantly higher in group three than group two
and four (P value <0.001) with no significant difference between groups
two and four. At 12 h, VAS was significantly higher in group one than
group two, three and four (P value <0.05) with no significant difference
among groups two, three and four. At 24 h, VAS was significantly
higher in group one than group two and four and was significantly lower
in group two than group three (P value <0.05) with no significant
difference between groups two and four and groups three and four.
reduction of postoperative pain is as a result of residual ketorolac in the
operative arm, and its redistribution to the systemic circulation after
tourniquet deflation.
• Intraoperative heart rate, mean arterial pressure and peripheral oxygen
saturation were insignificantly different among the studied groups.Summary
110
• Postoperative heart rate and mean arterial pressure was significantly
lower in both group two and four than group one and three at 1, 2, 4, 12
and 24 h (P value <0.05) and was insignificantly different at 6 h among
the studied groups.
• Onset of sensory block was significantly higher in group one than group
two and four (P value <0.05) with no significant difference between
group one and three, and among groups two, three and four. Onset of
motor block was insignificantly different among the studied groups.
Onset of sensory recovery was significantly lower in group one than
both groups two and four and was significantly higher in group two than
both groups three and four and was significantly lower in group three
than group four (P value <0.001) with no significant difference between
group one and three.
• Onset of motor recovery was significantly lower in group one than both
groups two and four and was significantly higher in group two than
group three, was significantly lower in group three than group four (P
value<0.05) with no significant difference between group one and three
and between group two and four.
• Surgeon and patient satisfaction was insignificantly different among the
studied groups.
• Intraoperative sedation, tourniquet pain and field congestion were
insignificantly different among the studied groups.
• Patients’ characteristics (age and gender) were insignificantly different
among the studied groups.
• Duration of surgery wasn’t significantly variable and inflation time were
significantly lower in group one than group three and group four (P
value <0.001) with no significant difference between group one and twoSummary
111
and was significantly lower in group two than both group three and
group four (P value <0.001) and was insignificantly different between
group three and four.
Conclusions
from the present study results, we could conclude that there is no
difference between early and late deflation of distal tourniquet in IVRA as
regard signs of LAST & effects on hemodynamics, addition of ketorolac to
local anesthetic in intravenous regional anesthesia showed positive results
regarding postoperative hemodynamic stability (lower heart rate and MAP),
lower pain score and shorter sensory block onset and longer recovery time of
sensory and motor blocks with no significant difference in surgeon and patient
satisfaction in IVRA for hand and forearm surgery.
Limitations
• A relatively small sample size.
• It was a single center study.
• Another limitation is that delayed postoperative pain after 24 hours were
not assessed.
Recommendations
• A larger scale studies with larger sample size and multicenter
collaboration are required.
• Comparative studies of ketorolac with other NSAIDS are required.
• Studies evaluating the effect of deflation time in lower limb surgery are
needed.
• Studies identify an optimal dose of ketorolac for IVRA can be
performed.