Intravenous regional anaesthesia for foot surgery.

Intravenous regional anaesthesia, confined to the distal lower limb and using bupivacaine 0.25%, was studied in 12 patients undergoing orthopaedic procedures to the feet. The technique was well accepted by both surgeons and patients and was free from serious toxicity. Bupivacaine was demonstrated in the systemic venous circulation in every case prior to surgery, whilst the tourniquet remained deflated. The plasma bupivacaine levels were less than that associated with toxicity, except in one case exhibiting signs of minor toxicity (bupivacaine plasma level 1.99 micrograms/ml-1). Reasons for the leak in spite of a well-conducted technique are discussed.