As with all other local anaesthetic blocks, resuscitation equipment should be immediately available. The drug of choice for IVRA is prilocaine as it is the least toxic local anaesthetic and has the largest therapeutic index. If prilocaine is not available, lignocaine is an acceptable alternative. It is essential that plain and not adrenaline-containing solutions are used. This can be increased to 50ml in muscular individuals or decreased to 30ml in small or frail patients.
Larger volumes are necessary in the leg eg.
Before beginning to perform the block, the patient's blood pressure should be measured. The tourniquet is then applied to the upper arm or thigh. It should never be placed on the forearm or lower leg as adequate arterial compression cannot then be obtained. Traditionally, this is done by tightly wrapping the distal part of the limb with an Esmarch rubber bandage, before inflating the tourniquet. This will allow venous blood to drain from the limb whilst preventing further arterial blood entering.