The efficacy of forearm IVRA for a surgical block is equal to that of a conventional upper arm IVRA, even with a reduced, non-toxic dosage of local anesthetic as explained in this systematic review. There were no severe complications and a faster onset of sensory block, better tourniquet tolerance and a dryer surgical field with the use of a forearm IVRA.

A systematic review and meta-analysis of the present evidence associated to the analgesic effectiveness with the performance of conventional, upper arm intravenous regional anaesthesia (IVRA) than the modified, forearm IVRA among adult patients going through approaches on the distal upper extremity.

CENTRAL, MEDLINE, and EMBASE were explored in French, German, Dutch, Spanish, and English to find randomised controlled trials. The onset of sensory block and a record of the anaesthesia quality level were considered as the primary outcomes, and local anaesthetic toxicity, need for sedation due to tourniquet pain and local anaesthetic dosage were as secondary outcomes. 

Three papers were selected for qualitative synthesis. Four more articles comprising seven reports were included in the parallel analysis that gave information on the rate of complications and success rate following the forearm IVRA. Forearm IVRA was discovered as useful as upper arm IVRA but with the benefit of a lower requirement for sedation due to less tourniquet pain.

Forearm IVRA is as efficient in achieving a surgical block as compared to a traditional upper arm IVRA, even with a lowered, non-toxic local anaesthetic dose. No severe complications were seen with forearm IVRA. Other advantages of this method comprise a quicker onset of sensory block, a dryer surgical field, and better tourniquet tolerance.