Comparison of consumption of local anesthetics inthe traditional upper arm Bier block and the forearm Bier block in upper extremity forearm and hand surgery

Introduction: 'Regional Intravenous Anesthesia', one of the regional anesthesia methods, is the regional block type that made by injection of local anesthetic solution inside the vein in the extremity of which its circulation is blocked by a tourniquet. It is generally used in the extremity surgery particularly in the upper extremity because of its reliability as well as the technique's ease. In this study, we aimed to compare the traditional upper arm Bier Block technique with the one cuff forearm block technique with a single tournique placed distal to the elbow joint in terms of onset of anesthesia, duration of anesthesia and analgesia, pain and consumption of local anesthetics during the surgery. Material and Methods: 60 adult patients ASA I - III between 18 - 65 ages scheduled for the wrist and hand surgery under the regional intravenous anesthesia were included in this study. In the 2015 April - October time patients were divided into two groups by simple randomized. Group 1 (n=30): Upper arm Bier Block (double tourni quet) 3 mg/kg % 0.5 prilocaine (maximum dose: 300 mg), Group 2 (n=30): one cuff Forearm block (RİVA) (single tourniquet) 2 mg/kg % 0.5 prilocaine (maximum dose: 200 mg). Prilocaine was administered in 60 - 90 seconds intravenously in both groups. The start and end time of surgery, duration of the tourniquet, time of the beginning of analgesia in the perioperative period were recorded. Blood pressure, heart rate, peripheral oxygen saturation, visual analog scale (VAS) and side effects (nausea and vomiting, it ching, hypotension, bradycardia, allergic reaction, tinnitus, metallic taste in the mouth etc.) were recorded in 5, 10, 20, 40, 60, 90 minutes in the intraoperative period and 5, 15, 30, 60, 120 minutes in the postoperative period. Results: There was no difference between two groups in terms of the start and end time of surgery, duration of the tourniquet, time of the beginnig of analgesia in the perioperative period (p >0,05).There was no difference between two groups in terms of blood pressure (p>0.05) , heart rate (p>0.05), peripheral oxygen saturation (p>0.05). Equivalent intraoperative analgesia was observed in both groups (p>0.05). Conclusion: We determined that one cuff forearm block was an efficient and safe method as well as using of traditiona l upper arm tourniquet because it needed less dose to reach a comparable level of anesthesia in the upper extremity surgery. Key Words : Regional anesthesia, local anesthetic, prilocaine .