Evaluation of the effect of transdermal nitroglycerin and intravenous neostigmine added to lignocaine for intravenous regional anesthesia

Abstract

Objective This study aimed to determine the advantage of a combination of transdermal nitroglycerine and neostigmine in intravenous regional anesthesia (IVRA). Background The aim of this study was to evaluate the effect of transdermal nitroglycerine, neostigmine, or both when added to lidocaine compared with lidocaine alone in the IVRA technique. Patients and methods Eighty patients (ASA grade I and II, aged 18-60 years) of both sexes were enrolled. The patients were divided randomly into groups as follows: group 1: the neostigmine group: a dose of 2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with the addition of 0.5 mg neostigmine was administered ( n = 20). Group 2: nitroglycerine group: a dose of 2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with the addition of 5 mg of transdermal nitroglycerine (a nitroglycerine patch was applied 2 h before the start of IVRA) was administered ( n = 20). Group 3: nitroglycerine-neostigmine group: a dose of 2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with the addition of 5 mg of transdermal nitroglycerine (a nitroglycerine patch was applied 2 h before the start of IVRA) and 0.5 mg neostigmine was administered ( n = 20). Group 4: lidocaine only (control group): participants received IVRA with 2 ml saline added to lidocaine (0.5 ml/kg) ( n = 20). Exclusion criteria Patients with ischemic heart disease, heart block, second or third degree, severe sinoatrial block, serious adverse drug reaction to lidocaine or amide local anesthetics, concurrent treatment with quinidine, flecainide, disopyramide, procainamide, Adams-Stokes syndrome, Wolff-Parkinson-White syndrome, allergic reactions to organic nitrates, allergy to nitroglycerin, allergy to the adhesive patches, hypersensitivity to neostigmine, myasthenia graves, a history of reaction to bromides, peritonitis, mechanical gastrointestinal, or urinary tract obstruction were excluded. Results Sensory and motor block onset times were shorter in the neostigmine-nitroglycerine group compared with all the other groups ( P P Conclusion We found that the addition of 0.5 mg neostigmine to a dose of 2.5 mg/kg of 0.5% lidocaine for IVRA with a 5 mg transdermal nitroglycerine patch improved the operating conditions and the quality of anesthesia and prolonged postoperative relief, with no adverse effects.