- cannula both sides - monitoring on - elevate arm above level of heart - inflate both cuffs of tourniquet 100mmHg above systolic BP (<300mmHg) - confirm absent arterial pulse and note time - inject **prilocaine** (0.5% 2.5mg/kg; 1/2 pt's weight is mL of medication required) slowly over 2 min - lasts 30-60 min - alternative is **lignocaine** diluted to 0.5% and 3mg/kg dose. - remove cannula on affected side + apply pressure - confirm anaesthesia - perform procedure - ensure cuff inflated for 20 min (no more than 60 min) - deflate cuff - observe 1 hour post; must have sensation + movement in arm prior to d/c - ensure to get post-reduction XR at appropriate time **Contraindications** - vascular compromise / compartment syndrome - allergy  - uncooperative patient  - uncontrolled severe HTN SBP > 200 - raynaud's disease - sickle cell disease - local anaesthetic sensitivity **complications** - [[Local anaesthetic systemic toxicity|LAST]] - ensure cuff stays up if has a seizure - [[Methemoglobinemia]]