Background: A straightforward and efficient anesthetic approach for hand and forearm surgery is intravenous regional anesthesia (IVRA), often known as the Bier Block. Dr. August Bier developed this method in 1908, and it offers total anesthesia as well as a bloodless operating room. Historically, the local anesthetic has been contained and a bloodless surgical field has been created by using an upper arm tourniquet. Major issues following IVRA with an upper arm tourniquet are uncommon, although they typically arise from systemic toxicity of local anesthetics upon tourniquet relaxation. Convulsions, coma, respiratory depression and arrest, and cardiovascular depression are signs of significant systemic local anesthetic responses, which might be lethal. Because of this, some medical professionals favor general anesthesia or other loco-regional procedures for hand and forearm surgery.
Objective: The aim of this review was to compare the effects of early vs late distal tourniquet deflation during hand and forearm surgery under intravenous regional anesthetic with or without ketorolac.
Methods: A comprehensive search was conducted in PubMed, Google Scholar, and Science Direct, from August 2000 to July 2021, using the keywords “Deflation, Distal tourniquet, Intravenous Regional Anesthesia, Ketorolac, Hand and Forearm Surgery". The reviewers evaluated relevant literature references as well. Only the most recent or complete study was taken into account. Examples of articles that weren't regarded as significant scientific research include unpublished manuscripts, oral presentations, conference abstracts, and dissertations. The lack of resources for translation has led to the ignoring of documents written in languages other than English.
Results: The reviewed literature showed that alternative adjustments in extremities surgery can improve IVRA. In short-term hand procedures, the forearm tourniquet may be chosen since it is simple to administer, has a minimal risk of toxicity, and offers an early block to healing. Conclusion: Depending on the patient's preferences, a Bier block with a forearm tourniquet can be utilized with or without further sedation or analgesics.