Anesthetic and Analgesic Effect of Neostigmine when Added to Lidocaine in Intravenous Regional Anesthesia

Abstract

Background: Intravenous regional anesthesia (IVRA) has various advantages during short surgical procedures in upper and lower limbs, but one of its disadvantages is minimal postoperative pain relief. Aim of the study: To evaluate the anesthetic and analgesic effect of adding 1 mg neostigmine to 0.5% lidocaine in IVRA. Patients and methods: This randomized double blind controlled clinical trial was carried out at Assiut University Hospital after the approval of its Ethical committee and after obtaining an informed consent from all the patients. Eighty ASA I or II patients who were scheduled for elective hand and forearm surgery were included. We excluded patients with chronic pain syndrome, Reynaud disease, sickle cell anemia, diabetes, pregnancy, lactation, drug allergy and psychological disorders. Patients were randomly assigned to control group who received 3 mg/kg 0.5% lidocaine plus 1 ml normal saline in 40 ml volume and neostigmine group who received 3 mg/kg 0.5% lidocaine plus 1 mg neostigmine in 40 ml volume. Patients were assessed for onset and recovery from the sensory and motor blocks, postoperative pain, analgesic request and incidence of complications. Results No statistically significant differences were observed between groups as regards demographic data, anesthetic or analgesic criteria or the incidence of complications . Conclusion: Addition of 1 mg neostigmine to 0.5% lidocaine in IVRA has no anesthetic or analgesic effect, and there is no increase in the incidence of complications. There are no biological facts that support its use as adjuvant to local anesthetic agents in IVRA.