The effects of axillary nerve block and intravenous regional anesthesia on ischemia-reperfusion injury induced by tourniquet

Abstract

Objective: We aimed to compare the effects of axillary nerve block and IVRA (Intravenous Regional Anesthesia) techniques used in patients planned to undergo hand surgery on tourniquet induced ischemia- reperfusion injury. Ischemia due to the use of tourniquet and the subsequent reperfusion cause oxidative stress in the organism. Oxidative stress contributes to postoperative morbidity. Method: The study included 65 patients who underwent hand surgery. The patients received axillary nerve block were assigned to Group A (n=33) and the patients received IVRA were assigned to Group I (n=32). Blood samples were collected at T1 before anesthesia, T2 immediately before tourniquet deflation, T3 5 min, T4 30 min and T5 4 hours after tourniquet deflation and serum TAS (total antioxidant level), TOS (total oxidant level), OSI (oxidant status index) and IMA (ischemia modified albümin) levels were studied. Results: Plasma concentration of IMA and OSI were significantly higher in Group A than in Group I at T2, T3, T4 time points. Plasma TOS level was higher in Group A than in Group I at time point T3. Plasma TAS level was significantly higher in Group I than in Group A at time points of T2, T3, T4. Conclusion: IVRA was more effective than axillary block in preventing ischemia- reperfusion injury induced by tourniquet used in hand surgery, but there was no difference between these two techniques in the fourth hour of reperfusion.