Anesthesia in a hand surgery unit.

Impressions of two different regional anesthetic techniques used in the management of 670 cases in a hand surgery unit are described. For operations at or below the wrist, subcutaneous ring anesthesia for the forearm tourniquet, together with local nerve block or local infiltrative anesthesia using Lignocaine, is very satisfactory. It is effective, simple, and safe, and it permits patient cooperation with the surgeon, who can readily evaluate motor activity because the flexor and extensor extrinsic muscles of the hand are then not paralyzed. For more extensive upper limb surgery, intravenous regional anesthesia with Bupivacaine is very effective, though toxicity might result if the tourniquet is unreliable or is released too rapidly. These effects are minimized by the intravenous infection of diazepam (5 to 10 mg) immediately prior to release the tourniquet.