Comparison of Two Different Concentrations for Foot and Ankle Surgeries During Intravenous Regional Anesthesia (IVRA): A Randomized Cohort Study

Abstract

Aim: Intravenous regional anesthesia (IVRA) is not commonly preferred in the lower extremity because of the toxic risks of high-dose local anesthetics. This study aimed to compare the use of two different concentrations of anesthetics with additional tourniquet application to reduce local anesthetics amount during the IVRA method for short-term foot and ankle surgeries. Material and Methods: In this prospective study, 40 patients were allocated to two groups with different concentration formulations of 200 mg lidocaine hydrochloride (Group 30 and Group 20). The groups were compared in terms of demographic data, tourniquet pain, operation time, hemodynamic indicators, and sedo-analgesia needs. Results: Demographic data were similar in the two groups. The mean tourniquet pain time was 41.66±6.61 minutes in Group 20 (n=9) and 36.76±7.17 minutes in Group 30 (n=13) (p=0.120). Perioperative sedo-analgesia consumptions were similar between the groups: weight-adjusted before/after tourniquet pain (p=0.390, p=0.207, p=0.536, and p=0.176), weight-adjusted/none total amount (p=0.425, p=0.578, p=0.268, and p=0.612), per minute before/after tourniquet pain (p=0.075, p=0.506, p=0.354, and p=0.055), for propofol and remifentanil, respectively. There was a significant difference between the propofol and remifentanil consumption per minute before and after the tourniquet pain in both groups: 5.61±1.67 and 14.58±6.62 mg/min propofol (p=0.001), and 4.79±1.69 and 7.86±1.55 mcg/min remifentanil (p=0.001), respectively. No patient had signs of local anesthetic toxicity. Conclusion: Low-dose sedo-analgesia can be used by a modified IVRA method in the management of tourniquet discomfort that may occur until the tourniquet pain develops.