الفهرس 
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Abstract
SUMMARY
Intravenous regional anesthesia (IVRA), described by Gustav Bier, is simple, reliable, cost-effective, rapid recovery and quite safe for minor surgical procedures of the limbs and of especial advantage in management of high risk patients.
The fact, that forearm IVRA may provide the same quality of perioperative anesthesia and analgesia as conventional upper arm IVRA and that it may decrease the dose of LA to nontoxic levels, is beneficial.
Limitations of this block include tourniquet discomfort, short duration of block and absence of post-operative analgesia. Trying to overcome these effects and improve the quality of the block various drugs have been added to local anesthetic. Some recent studies proved the beneficial role of the using of nitroglycerine (NTG) as an adjuvant but the results have been controversy.
The aim of this study was to compare between the efficacy of using forearm IVRA and standard upper arm IVRA for wrist and hand surgery. Also, our study investigated the effects of NTG when added to lidocaine for IVRA as compared to fentanyl when added to lidocaine in patients undergoing wrist and hand surgery as regarding sensory and motor block onset and recovery time, the quality of tourniquet pain relief, hemodynamic stability and postoperative analgesia.
This randomized clinical study, including 100 patients, was carried out at Beni-Suef university hospital, after approval by the department of Anesthesiology and other involved departments, faculty of medicine, Beni-Suef University.
Regarding sensory block onset time, there was a statistically significant rapid onset in group III (UN) compared to group I (UF) and group II (FF). Also, there was a statistically significant rapid onset in group IV (FN) compared to group I (UF) and group II (FF).
Regarding motor block onset time, there was a statistically significant rapid onset in group III (UN) compared to group I (UF) and group II (FF). Also, there was a statistically significant rapid onset in group IV (FN) compared to group I (UF) and group II (FF).
The current study showed that there was a reduction in postoperative diclofenac requirement in 1st 24 h (mg) in group III (UN) compared to group I (UF) and group II (FF) doses. Also, there was a statistically significant reduction in postoperative diclofenac requirement in 1st 24 h (mg) in group IV (FN) compared to group II (FF) dose.
However, the two techniques had similar effects on onset of tourniquet pain, intraoperative fentanyl dose, both sensory and motor block recovery time, postoperative time of first analgesic administration, the quality of anesthesia for both the patient and surgeon, the incidence of tourniquet pain, local and systemic complications in different groups.
Furthermore, no drug-related changes in hemodynamic parameters (MBP and HR) and peripheral oxygen saturation (Spo2) were pointed in our study subjects.
from our present study, we can conclude that patients can almost equally benefit from the modified forearm tourniquet IVRA with effects comperable to that of the standard upper arm tourniquet technique, with the advantage of using non-toxic dose of local anesthetics.
The administration of nitroglycerin as an adjuvant to lidocaine has been found superior to fentanyl combined to lidocaine with respect to shortening the onset of sensory and motor block and reduction in postoperative diclofenac requirement in 1st 24 h without severe local and systemic complications in different groups.