Intravenous Regional Anaesthesia With Lignocaine, Fentanyl And Pancuronium – Prospective Randomised Controlled Double Blind Study.

Abstract

Intravenous Regional Anaesthesia (IVRA) is a simple and effective technique for upper limb distal surgery. However, a relatively large dose of LA is required to induce motor and sensory blockade. Lignocaine 3mg/kg as a 0.5% solution is needed to ensure adequate analgesia. Systemic toxic reactions (convulsions, coma, cardiac arrest) can occur when the tourniquet deflates unexpectedly during the procedure or when it deflated intentionally at the end of short surgery.Therefore we conducted this prospective randomized double blind study to compare and evaluate the effects of addition of fentanyl and pancuronium to reduced dose of LA against the standard practice of 0.5% lignocaine.In this study, 75 patients of both sexes in the age group more than 18 years belonging to ASA 1 and 2 undergoing both elective and emergency surgeries of the forearm and hand were divided randomly into group L, group P and group F with 25 patients in each group.In patients belonging to group L, 40 cc of 3mg/kg of 0.5% lignocaine diluted in normal saline was used for administering IVRA, and in patients of group F 40 cc of 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1mg/kg , and in patients of group P 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1mg/kg and pancuronium 0.5mg was used.The time for onset of sensory blockade in group L was 11.76.± 3.08 minutes , group F was 12.96±3.06 minutes , and group P was 10.20±3.52 minutes which was clinically comparable in all the groups. However the time for onset of motor blockade was significantly delayed in group F (21.1±2.7 minutes) as compared to other two groups: group L (12.5±2.6minutes and group P (11.36±3.5 minutes). The patients in group P were showing significantly excellent muscle relaxation and excellent intraoperative analgesia as compared to other two groups. Post operative analgesia in group P (56.4±2.6minutes ) was significantly longer as compared to group F (46.8 ±4.9 minutes) and group L (39 ± 8 minutes). Our results showed that hemodynamic parameters like pulse rate, blood pressure, respiratory rate were well maintained throughout the intra and post operative period in all the patients of all the groups. There were no major untoward side effects were noticed.Thus from the present study, we conclude that the addition of fentanyl 1mg/kg and pancuronium 0.5mg to 0.25% of lignocaine enhances lignocaine action and results in-Adequate sensory and motor block.Excellent intraoperative analgesia.-Excellent intraoperative muscle relaxation. Thus, using this combination the dose of lignocaine for IVRA can be reduced to a non toxic level for the same quality of analgesia and at the same time not offer any post analgesic benefit as all study patients were required supplement of analgesics post operatively after about 50-60 minutes.. INTRODUCTION Intravenous regional anesthesia was first described by August Gustav Bier in 1908. This technique is a simple, easy to administer, effective and reliable method for anesthesia. It involves intravenous injection of local anesthetics into the limb on which surgery is to be performed after the limb is exsanguinated and a tourniquet has been applied proximally. It is the surest way of obtaining a block with a very minimal failure rate, and has gained immense popularity more so for upper limb surgeries. Besides it is extremely useful for emergency surgeries. Being a regional technique it avoids all the complication of general anesthesia, more so in patients coming for emergency surgery as well as patients belonging to ASA class 3 and 4. However the dose of local anesthetic agent required to induce motor and sensory blockade has the potential to cause systemic local anesthetic toxicity. Therefore various methods have been tried to reduce the dose of Local anesthetic used in Intravenous regional anesthesia ,such as alkalization of the local anaesthetic solution, addition of an opioid, muscle relaxant , non steroidal anti-inflammatory drugs, potassium, and Ketamine 9 with various results. We conducted this prospective randomized double blind Intravenous Regional Anaesthesia With Lignocaine, Fentanyl And Pancuronium – Prospective Randomised Controlled Double Blind Study. 2 of 9 study to know the effect of combining fentanyl 1/kg alone and fentanyl1g/kg plus pancuronium 0.5mg with reduced dose of lignocaine( 0.25%) for Intravenous regional anesthesia. AIMS & OBJECTIVES To study the effect of IVRA with lignocaine 0.5% with lignocaine 0.25% plus fentanyl 1/kg and lignocaine 0.25% plus fentanyl1g/kg plus pancuronium 0.5mg with respect to : Time of onset of sensory block. Time of onset of motor block The degree of muscle relaxation Intraoperative analgesia.