Abstract
Background and purpose: The main and the most known complication of intravenous regional anesthesia (IVRA) is systemic toxicity due to local anesthetics that occurs following the accidental tourniquet release immediately after injection. This study aims to evaluate the effect of adding ketamine to lower dose of lidocaine on reducing the dose and side effects of lidocaine. Materials and Methods: In this randomized clinical trial, 60 patients undergoing the surgery of upper limb below the elbow under IVRA were randomly divided into two groups. In group 1 (control group), 40 ml lidocaine 0.5% (200 mg) and in group 2 (intervention group), 40 ml lidocaine 0.25% (100 mg) plus 40 mg of ketamine 0.1% injected intravenously. Outcomes included postoperative pain at 15, 30 and 60 minutes after surgery. The pain of the patients was assessed by using the Visual Analogue Scale (VAS Score). Results: Both groups were comparable in demographic and surgical parameters. The average pain based on the VAS score at 15, 30 and 60 minutes after surgery was similar in both groups and there was no significant difference between the two groups (p> 0.05). Moreover, postoperative complications including unconsciousness, restlessness, dizziness, nausea, vomiting, tinnitus, seizure, delirium and hallucination had no significant differences (p> 0.05). Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects.
Highlights
Using general anesthesia for surgery has always had complications such as cardiovascular complications, pulmonary complications, malignant hyperthermia, and so on
Tourniquet pain and poor postoperative analgesia are Siamak Yaghubi et al.: Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain common problems associated with intravenous regional anesthesia (IVRA) [4]
In this study addition of ketamine to lower dose of lidocaine in patients receiving IVRA reduced the postoperative pain without causing significant side effects
Summary
Using general anesthesia for surgery has always had complications such as cardiovascular complications (dangerous arrhythmia), pulmonary complications (possibility of apnea, airway obstruction, aspiration), malignant hyperthermia, and so on. IVRA, created by August Karl Gustav Bier about 100 years ago, is a simple, safe, and effective technique of providing anesthesia for short surgical procedures on the hand and forearm for an anticipated duration of 60 to 90 minutes [3]. Of the benefits of IVRA, which is feasible for upper and lower limb surgeries, are being easy and fast, having high success rate, fast recovery, controlling the extent of the block and muscle relaxation techniques, availability in open or closed short surgeries In this method, the risks of general anesthesia such as apnea, aspiration and cardiovascular complications can be avoided [5-6]. Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects
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