Regional Anaesthesia by the Intravenous Route

Abstract

Further experience in the value, effectiveness, and safety of intravenous regional anaesthesia is presented. This method was used by house-surgeons working in a busy casualty department to treat a wide variety of conditions affecting the distal parts of the limbs. It was most often used in the treatment of Colles fractures and hand and finger infections. Successful anaesthesia was achieved in 113 out of 128 patients on whom this method was employed. An attempt is made to explain the mode of action of a local anaesthetic when injected into the venous system of an isolated limb segment. Rapid dispersion of anaesthetic solution occurs when distal veins are used. Direct contact with main nerve-trunk fibres is facilitated by the permeability of venules and the richness of the vasa nervorum. Comment is made on the rapid return of normal sensation when the tourniquet is removed at the end of the procedure and on the role of ischaemia in the production of anaesthesia by this technique. Nerve-conduction tests demonstrated that ischaemia does not, initially, contribute to anaesthesia. No serious toxic reactions were encountered using 0.5% plain lignocaine. The dosage did not exceed 200 mg. for the arm and 400 mg. for the leg. We are indebted to Professor Roland Barnes for his helpful criticism in the preparation of this paper and to Mr. R. Louden-Brown for the illustrations. © 1965, British Medical Journal Publishing Group. All rights reserved.