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March 6, 1967

Drug Distribution Following Intravenous Regional Anesthesia

Author Affiliations

From the Greenwich (Conn) Hospital (Dr. Knapp) and Food and Drug Research Laboratories, Inc., New York (Dr. Weinberg).

JAMA. 1967;199(10):760-762. doi:10.1001/jama.1967.03120100122036

THE technique of intravenous regional anesthesia, similar to that produced by Bier in 1908,1 has achieved considerable interest and popularity since its description by Holmes in 1963 and 1964.2,3

The sudden release of 150 to 200 mg of lidocaine into the systemic circulation is a danger that was the subject of an editorial in The Journal in 1965.4 A warning was raised against the clinical use of this technique until basic studies have given answers to the following questions: (1) What is the rate of degradation (if any) of the anesthetic per unit of mass within the limb? (2) How much of the anesthetic is present intravascularly within the limb at the time of tourniquet release?

This investigation has attempted to clarify some of these unknowns with lidocaine tagged with carbon 14, particularly the fate of lidocaine administered intravenously to an exsanguinated limb fitted with a tourniquet.