Forearm rescue cuff improves tourniquet tolerance during intravenous regional anesthesia

BACKGROUND AND OBJECTIVES: Tourniquet pain during intravenous regional anesthesia (IVRA) of the upper limb is common and can limit tourniquet inflation time. We hypothesize that a forearm rescue cuff is better tolerated than the traditional rescue cuff of a double-cuff tourniquet. METHODS: After Institutional Review Board (IRB) approval and informed consent, 10 healthy unmedicated volunteers took part in a prospective, randomized, cross-over study. Following inflation of the proximal tourniquet cuff on the upper arm, a standardized IVRA with 0.5% lidocaine, 0.6 mL/kg was administered. When the volunteer complained of tourniquet pain, or at 30 minutes, the initial cuff was changed to a rescue cuff. During session A, the rescue cuff was the traditional distal cuff of the double-cuff tourniquet. During session B, a single forearm cuff was used. When the volunteer experienced the same level of tourniquet pain, the rescue cuff was deflated and the study session ended. The tourniquet time for the rescue cuff, the visual analog scale (VAS) pain score, and the incidence and duration of side effects were recorded. RESULTS: The forearm rescue cuff was tolerated significantly longer than the arm rescue cuff (49 +/- 15 v 29 +/- 11 minutes, 95% confidence interval [CI] 7 to 32 minutes, P </=.005). When the forearm rescue cuff was used, VAS scores were lower and side effects were of shorter duration (6 +/- 5 v 15 +/- 7 minutes, P <.001). CONCLUSIONS: A forearm rescue cuff is better tolerated than an arm cuff double tourniquet during IVRA, allowing for longer tourniquet times. It is also associated with lower pain scores and shorter duration of local anesthetic side effects.