Intravenous Regional Anesthesia of the Upper Extremity in Children

One of the more perplexing problems facing the anesthesiologist is provision of adequate and safe anesthesia for young children who have suffered fractures or large lacerations of the hand and forearm. Most children who receive general anesthesia for major suturing or closed reduction of fractures require hospital admission for at least 8 to 24 hours. This communication is a report of a safe and effective method of handling these procedures on an outpatient basis.

A 7-year-old girl, weighing 20 kg (44 lb), was admitted to the operating room from the emergency room for full-thickness free skin graft to the left middle finger from which the tip had been avulsed. She had eaten a large evening meal shortly before the injury was sustained.

Though moderately apprehensive, she quickly agreed to "just one needle stick" for anesthesia. Two narrow inflatable tourniquets were placed on the upper arm. A 25-gauge scalp vein needle