Intravenous regional analgesia with prilocaine for foot surgery

Intravenous regional analgesia for foot surgery with an ankle tourniquet was used for 48 cases. Prilocaine 0.5% 3 mg/kg body weight was injected either quickly over about 2 minutes or slowly over about 5 minutes. The tourniquet was inflated either to occlusion pressure plus 100 mmHg or to occlusion pressure plus 200 mmHg. Plasma prilocaine levels were measured while the tourniquet remained inflated and after release of the tourniquet. All four techniques resulted in a low incidence and magnitude of prilocaine leak and low prilocaine plasma levels after tourniquet release. The data suggest that slow injection with the high tourniquet inflation pressure is better, although the differences in leakage with an intact tourniquet were not statistically significant. Excellent analgesia was achieved in over 90% of patients and there were no complete failures. No dangerously high prilocaine plasma levels were produced and no serious side effects observed.