A Comparative Study Between Arm Intravenous Regional Anesthesia Versus Forearm Intravenous Regional Anesthesia in Patients Undergoing Hand and Wrist Surgery

Abstract

Background: Intravenous regional anesthesia (IVRA) is a widely used technique for hand and wrist surgeries. However, conventional upper arm IVRA requires higher anesthetic doses, which increases the risk of systemic toxicity. Forearm IVRA offers potential advantages, including lower anesthetic requirements and improved tourniquet tolerance. Objectives: The study aims to compare the efficacy, analgesic effectiveness, and safety of forearm versus upper arm IVRA in elective hand and wrist surgeries. Methods: In this prospective, randomized, open-label clinical trial, 140 adult patients, classified as American Society of Anesthesiologists (ASA) physical status I - II and aged 21 - 65 years, scheduled for elective hand or wrist surgery at Ain Shams University Hospitals, were randomized into two equal groups: Upper arm IVRA and forearm IVRA. The outcomes measured included block success, onset of analgesia, tourniquet pain-free duration, pain scores, rescue analgesia requirements, and patient and surgeon satisfaction. Results: Block success rates were similar between the forearm and upper arm IVRA groups (94.3% vs. 91.4%, P = 0.512). Forearm IVRA demonstrated a significantly longer tourniquet pain-free duration (45.7 ± 4.6 vs. 43.2 ± 4.7 minutes, P = 0.002) and a longer time to the first postoperative analgesic request (8.9 ± 0.9 vs. 5.8 ± 1.0 hours, P < 0.001), with lower 24-hour nalbuphine consumption (11.4 ± 4.2 vs. 28.7 ± 3.4 mg, P < 0.001). Patient satisfaction was higher in the forearm group (P < 0.001), while surgeon satisfaction did not differ significantly (P = 0.145) Conclusions: Forearm IVRA is an effective and safe alternative to upper arm IVRA for hand and wrist surgeries, offering superior tourniquet tolerance, prolonged analgesia, reduced opioid requirements, and higher patient satisfaction