Influence of Addition of Ondansetron or Ketorolac on Levobupivacaine in Bier Block for Upper Limb Surgeries

Abstract

Background: Intravenous administration of a local anesthetic into a tourniquet occluded limb, continued to be in favor due to simplicity and reliability with rapid onset of the technique and decreased systemic toxicity. Objectives: Our study aimed to compare between the effects of adding ondansetron 8 mg or ketorolac 30 mg to levobupivacaine 0.125% for IVRA on duration of postoperative analgesia Patients and methods: 60 adult patients of both sex who are matched with American Society of Anesthetists (ASA, I - II). Their ages ranged between 21–60 years old and scheduled for upper limb surgery under intravenous regional anesthesia (IVRA). Patients were randomly divided into three equal groups (20 patients each). Group (L): levobupivacaine (0.125%) + IV saline, (control group). Group (LO): levobupivacaine (0.125%) + IV ondansetron (8 mg/kg). Group (LK): levobupivacaine (0.125%) + IV ketorolac (30mg). All patients received levobupivacaine (0.125%) diluted with 0.9% normal saline to a total volume of 40 ml. Results: Onset of sensory and motor block was rapid in ondansetron group than other groups. Duration of offset time of sensory and motor block was significantly prolonged in ketorolac group (p < 0.0001). Visual analog scale was significantly lower in ketorolac (p < 0.001) and ondansetron group than in control group. Duration of postoperative analgesia was longer in ketorolac group and ondansetron group than in control group (p < 0.001). Postoperative total analgesic consumption in 24h was significantly less in ketorolac group than in ondansetron group and control group (P < 0.002). Conclusion: T he results of the present study revealed that addition of ondansetron or ketorlac to levobupivacaine for IVRA improved quality of anesthesia, reduced postoperative analgesic consumption with rapid onset of sensory block with ondansetron group than with ketorolac group. Moreover, the time to the first analgesic requirement after surgery was prolonged with ketorolac group than with ondansetron group when compared to the control group.