Spinal anaesthesia of the upper limb; the update and the future

Abstract

In 1908 August Bier, Professor of surgery at Berlin, described an unusual method of producing analgesia of a limb. He exsanguinated the arm or leg by means of a tourniquet, and injected a local anaesthetic solution into a vein. The recent resurgence of interest in this technique, culminating in this Symposium, is not only evidence of its usefulness even today, but also reflects the paucity of our knowledge of the exact mechanism of the production of anaesthesia in this method. However, in 1908 the principle was truly revolutionary, and we have good reason to be thankful that “Bier was always an innovator”. There has been an increase in the number of surgical procedures done in the ambulatory environment. Single-injection and infusion systems utilizing portable, disposable elastomeric pumps help provide safe pain control in this environment. At the present time, the management of postoperative pain is the major indication for continuous brachial plexus (CPB) blockade. The development of sophisticate surgical techniques for microvascular and reattachment surgery of the upper extremity has increased the demand for continuous techniques. Good peripheral blood flow in the transplant during the operation and in the postoperative period is important. The use of continuous techniques is particularly warranted during the postoperative period to provide analgesia, sympathetic blockade, and increased blood flow to the injured extremity. Key word: Blood Lactate Leveland Central Venous Oxygen Saturation as a Goalfor Resuscitation in Patients with Severe Sepsis and Septic Shock