Intravenous Regional Anesthesia Research Articles

Acid-sensing ion channels blockade attenuates pressor and sympathetic responses to skeletal muscle metaboreflex activation in humans.

In animals, the blockade of acid-sensing ion channels (ASICs), cation pore-forming membrane proteins located in the free nerve endings of group IV afferent fibers, attenuates increases in arterial pressure (AP) and sympathetic nerve activity (SNA) during muscle contraction. Therefore, ASICs play a role in mediating the metabolic component (skeletal muscle metaboreflex) of the exercise pressor reflex in animal models. Here we tested the hypothesis that ASICs also play a role in evoking the skeletal muscle metaboreflex in humans, quantifying beat-by-beat mean AP (MAP; finger photoplethysmography) and muscle SNA (MSNA; microneurography) in 11 men at rest and during static handgrip exercise (SHG; 35% of the maximal voluntary contraction) and postexercise muscle ischemia (PEMI) before (B) and after (A) local venous infusion of either saline or amiloride (AM), an ASIC antagonist, via the Bier block technique. MAP (BAM +30 ± 6 vs. AAM +25 ± 7 mmHg, P = 0.001) and MSNA (BAM +14 ± 9 vs. AAM +10 ± 6 bursts/min, P = 0.004) responses to SHG were attenuated under ASIC blockade. Amiloride also attenuated the PEMI-induced increases in MAP (BAM +25 ± 6 vs. AAM +16 ± 6 mmHg, P = 0.0001) and MSNA (BAM +16 ± 9 vs. AAM +8 ± 8 bursts/min, P = 0.0001). MAP and MSNA responses to SHG and PEMI were similar before and after saline infusion. We conclude that ASICs play a role in evoking pressor and sympathetic responses to SHG and the isolated activation of the skeletal muscle metaboreflex in humans. NEW & NOTEWORTHY We showed that regional blockade of the acid-sensing ion channels (ASICs), induced by venous infusion of the antagonist amiloride via the Bier block anesthetic technique, attenuated increases in arterial pressure and muscle sympathetic nerve activity during both static handgrip exercise and postexercise muscle ischemia. These findings indicate that ASICs contribute to both pressor and sympathetic responses to the activation of the skeletal muscle metaboreflex in humans.

Local anesthesia for the eye and foot

The benefits of using local anesthetic techniques for medical and surgical procedures in ruminants are many, including avoidance of general anesthetic risks and cost, rapid recovery and return to function, and preservation of animal welfare. Certain blocks, namely the Peterson Eye Block, require some practice to achieve the block’s full potential, but are performed easily over time with practice. The Peterson Eye Block and the auriculopalpebral nerve block for ocular procedures and the Bier (regional intravenous anesthesia) Block and interdigital block for procedures of the foot are presented.

Evaluation of Ketamine as an Adjuvant to Lidocaine in Intravenous Regional Anesthesia for Upper Limb Surgery

AbstractBackground: Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique but tourniquet pain is a limitation. Ketamine in subanesthetic dose is used as an adjuvant to IVRA to improve analgesia and to impair tourniquet pain.Aim of Study: Is to illustrate the effect of ketamine as adjuvant to lidocaine used for IVRA in patients undergoing upper limb surgery.Patients and Methods: This double-blind randomized controlled study was carried out on 60 patient, ASA I and II, 20-40 years, scheduled for elective minor upper limb surgery. Patients were classified into 2 groups (30 each): Group I (IVRA with lidocaine only) received 3mg/kg lidocaine 0.5% diluted with saline to 40ml and group II (IVRA with lidocaine and ketamine) received 3mg/kg lidocaine0.5% plus 50mg ketamine diluted with saline to 40ml. MAP, HR and SpO2 were measured before, after tourniquet application, during the surgery every 15 minute, and every 30 minutes after deflating the tourniquet. Type & duration of the operation, onset & duration of sensory & motor block were measured. VAS was recorded at 1, 2, 3, 6, 12, 18 and 24h after operation, time of first rescue analgesia, total analgesic given and any undesirable side effects.Results: Demographic data, duration of operation and hemodynamic changes (MAP, HR and SpO2) were comparable. Onset of sensory and motor block were shorter in Group II than in Group I, but the duration of sensory and motor block was prolonged. In Group II, first dose of IV analgesic was delayed and the amount of pethidine was significantly de-creased. VAS and severity of tourniquet pain in group II were significantly decreased.Conclusion: Adding ketamine 50mg to lidocaine for IVRA has faster and prolonged sensory and motor block and delayed tourniquet pain with better quality of postoperative analgesia.

Intravenous regional anesthesia

Intravenous regional anesthesia. Short duration hand operations. Open wounds, lengthy operations, local infections, polyneuropathy, Raynaud syndrome, allergy to local anesthetics. Insertion of an intravenous cannula, attachment of adouble lumen cuff, Esmarch's tourniquet, injection of the local anesthetic, stepwise pumping up the tourniquet, surgery, stepwise removal of the tourniquet. Postoperative monitoring of the patient after the end of anesthesia. Over a time period of 2 years (January 2017-December 2018) 90 operations of the hand were carried out with the patient under intravenous regional anesthesia (IVRA). The average age of the patients was 61years. After surgery the patients were questioned according to the criteria of the quality of recovery‑9 score according to Myles in the German version of Eberhard etal. (2002). The tourniquet could be removed on average 29 min after surgery. No intraoperative or postoperative complications occurred. Therefore, the IVRA represents areliable and simple form of anesthesia especially for surgery of the hand.

Observational Study of Lignocaine Alone and Lignocaine with Dexmedetomidine for Intravenous Regional Anaesthesia

Observational Study of Lignocaine Alone and Lignocaine with Dexmedetomidine for Intravenous Regional Anaesthesia

Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries

Background: Upper limb surgeries may be done under general anaesthesia or other methods such as nerve block or regional anaesthesia such as intravenous regional anesthesia (IVRA). Intravenous regional anesthesia has many advantages such as cost effectiveness, day case surgeries and reduced hemorrhage risk. Objective: The primary objective was to evaluate the effect of paracetamol and dexamethasone when combined with lidocaine on the depth and duration of IVR anesthesia in upper limbs. The secondary objective was to evaluate the onset of tourniquet-associated pain, time of 1st analgesic request, total opioid consumption and haemodynamic stability. Patients and Methods: Patients of this study were classified into 4 groups, 1 st group received 3 mg/kg lidocaine 2% completed by normal saline to 40 cc total volume without any additives and named as group L. 2 nd group received 3 mg/kg lidocaine 2% plus 8 mg dexamethason completed by normal saline to 40 cc total volume and named as group D. 3 rd group received 3 mg/kg lidocaine 2% plus 250 mg paracetamol completed to 40 cc total volume and named as group P. 4th group received 3 mg/kg lidocaine 2% plus 8 mg dexamethasone plus 250 mg paracetamol completed to 40cc total volume and named as group LDP. These groups were evaluated for haemodynamics and onset of sensory and motor block and time of recovery of sensory and motor block as well as intraoperative VAS score and fentanyl consumption. Results: As regard average values of intraoperative VAS, 4 th group had the lowest numbers then 2nd group, 3 rd group then 1st group which had the highest numbers. As regard the time to 1st analgesic request, the 1 st group showed the shortest time meanwhile the 4 th group showed the longest time to 1st analgesic request while 2 nd and 3rd groups were in between. Total opioid consumption was the least among the 4th group in comparison with the other three groups especially the 1st one, which showed the highest consumption. Finally, 4 th group proved to be the best one as regarding good anaesthesia and analgesia and reduction in intraoperative pain score as well as reduction in opioid consumption. Conclusion: Paracetamol and dexamethasone when combined to lidocaine in intravenous regional anaesthesia in upper limb produce synergistic effect on sensory and motor block, reduce intraoperative pain score and decrease amount of intra operative opioid consumption.

Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries

Background: Upper limb surgeries may be done under general anaesthesia or other methods such as nerve block or regional anaesthesia such as intravenous regional anesthesia (IVRA). Intravenous regional anesthesia has many advantages such as cost effectiveness, day case surgeries and reduced hemorrhage risk. Objective: The primary objective was to evaluate the effect of paracetamol and dexamethasone when combined with lidocaine on the depth and duration of IVR anesthesia in upper limbs. The secondary objective was to evaluate the onset of tourniquet-associated pain, time of 1st analgesic request, total opioid consumption and haemodynamic stability. Patients and Methods: Patients of this study were classified into 4 groups, 1 st group received 3 mg/kg lidocaine 2% completed by normal saline to 40 cc total volume without any additives and named as group L. 2 nd group received 3 mg/kg lidocaine 2% plus 8 mg dexamethason completed by normal saline to 40 cc total volume and named as group D. 3 rd group received 3 mg/kg lidocaine 2% plus 250 mg paracetamol completed to 40 cc total volume and named as group P. 4th group received 3 mg/kg lidocaine 2% plus 8 mg dexamethasone plus 250 mg paracetamol completed to 40cc total volume and named as group LDP. These groups were evaluated for haemodynamics and onset of sensory and motor block and time of recovery of sensory and motor block as well as intraoperative VAS score and fentanyl consumption. Results: As regard average values of intraoperative VAS, 4 th group had the lowest numbers then 2nd group, 3 rd group then 1st group which had the highest numbers. As regard the time to 1st analgesic request, the 1 st group showed the shortest time meanwhile the 4 th group showed the longest time to 1st analgesic request while 2 nd and 3rd groups were in between. Total opioid consumption was the least among the 4th group in comparison with the other three groups especially the 1st one, which showed the highest consumption. Finally, 4 th group proved to be the best one as regarding good anaesthesia and analgesia and reduction in intraoperative pain score as well as reduction in opioid consumption. Conclusion: Paracetamol and dexamethasone when combined to lidocaine in intravenous regional anaesthesia in upper limb produce synergistic effect on sensory and motor block, reduce intraoperative pain score and decrease amount of intra operative opioid consumption.

Analgesic effect of paracetamol as an adjuvant to lignocaine in upper limb surgeries under intravenous regional anaesthesia (IVRA)

Materials and methods: A total 120 cases belong to ASA grade I or II, between age group 21-60 years undergoing upper limb surgeries were divided into two groups. Group A administered with 2% lignocaine (10 ml) with paracetamol (30 ml) and group 2 administered with 10ml 2% lignocaine with normal saline (30ml). Onset of motor and sensory blockade and recovery duration, intraoperative pain assessment by using 10 cm visual analogue scale, utilization of intra operative analgesia and need of post-operative analgesia, Post-operative patient satisfaction were evaluated.

SPECIFIC ASPECTS OF ANESTHESIA IN PROCTOLOGY

Proctology, as a domain of abdominal surgery, deals with the treatment of diseases affecting the end part of the large bowel, it’s terminal 20 cm, to which anus anatomically belongs as well. In view of the physiological role of this part of the digestive tract (stool control), all the diseases and disorders in the region cause patient discomfort and produce significant problems in everyday life. On account of that, diagnostic management should be performed promptly in order that effective treatments could be introduced as soon as possible. The most commonly used techniques of anesthesia in proctology are local anesthesia, independent or in combination with intravenous analgosedation, regional anesthesia (spinal and epidural), and general anesthesia. Local anesthesia combined with analgosedation has been the preferred approach in recent studies, since it is able to provide adequate settings for the planned surgery, patient comfort and minimization of side effects. An adequate anesthesia technique reduces metabolic response to surgical stress and length of hospitalization, which markedly affects cost-effectiveness of the treatment.

Acid‐Sensing Ion Channels Blockade Attenuates Pressor and Sympathetic Responses to Skeletal Muscle Metaboreflex Activation in Humans

In animals, the blockade of acid‐sensing ion channels (ASICS), cation pore‐forming membrane proteins located in the free nerve endings of group IV afferent fibers that are activated by acidic pH transients, attenuates reflex increases in sympathetic nerve activity (MSNA) and blood pressure (BP) during muscle contraction. These findings indicate that ASICS have an important role in mediating the metabolic component (skeletal muscle metaboreflex) of the exercise pressor reflex in animal models. Nonetheless, it is still unclear whether these findings can be translated to humans. We then tested the hypothesis that ASICS play a role in evoking the skeletal muscle metaboreflex in humans, quantifying beat‐by‐beat mean BP (MBP, Finometer), MSNA (peroneal nerve, microneurography) and heart rate (HR, ECG) in 11 healthy young men (N = 11) during rest, static handgrip exercise (SHE, 2 min at 35% of the MVC) and post‐exercise muscle ischemia (PEMI, 2 min) before (BFA) and after local infusion of amiloride (AFA −0.75 mg/mL), an antagonist of ASICs, in saline (2.5% of total forearm volume) via modified Bier block (regional intravenous anesthesia). In an additional protocol, participants (N = 7) underwent the experimental procedures before (BFS) and after (AFS) venous infusion of a similar amount of saline via modified Bier block. MBP responses were slightly but significantly attenuated during SHE after amiloride infusion (BFA +29.6 ± 6.1 vs. AFA +24.3 ± 7.0 mmHg, p = 0.001). A smaller increase in MSNA (N = 9) was also observed as a consequence of ASICs blockade (BFA +14.5 ± 9.6 vs. AFA +10.7 ± 6.5 bursts/min, p = 0.004). Equivalent SHE‐induced increases in HR were observed before and after ASICs blockade (p > 0.05). Amiloride infusion attenuated the PEMI‐induced increases in both MBP (BFA +25.8 ± 6.9 vs. AFA +16.3 ± 6.4 mmHg, p = 0.0001) and MSNA (BFA +16.2 ± 9.2 vs. AFA +8.4 ± 8.0 bursts/min, p = 0.0001). In the additional protocol, SHE‐evoked increases in MBP (BFS +28.7 ± 12.2 vs. AFS +27.0 ± 9.8 mmHg, p = 0.477), MSNA (N = 5, BFS +10.0 ± 8.6 vs. AFS +13.0 ± 9.4 burst/min, p = 0.208) and HR (BFS +32.0 ± 12.4 vs. AFS +37.2 ± 22.5 bpm/min, p = 0.265) did not differ before and after saline infusion. Similar observations were obtained for MBP (BFS +24.2 ± 14.2 vs. AFS +23.7 ± 10.4 mmHg, p = 0.830) and MSNA (BFS +10.0 ± 8.6 vs. AFS +13.0 ± 9.4 burst/min, p = 0.208) during PEMI. Therefore, these findings indicate that ASICs play a role in evoking pressor and sympathetic responses to both SHE and isolated activation of the skeletal muscle metaboreflex in humans.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A case of epileptic seizure due to lidocaine local anesthesia

Lidocaine is an amide-structured local anesthetic commonly used in practice in anesthesiology. Because of its rapid onset, it is frequently used in topical and infiltration anesthesia, regional blocks, regional intravenous anesthesia (RIVA) and general anesthesia to suppress hemodynamic responses to intubation, as well as some cardiac arrhythmias and epileptic seizures. Here, we present a case with seizures and impaired consciousness following iv lidocaine treatment during sedoanalgesia without a history of epilepsy. A thirty-seven-year-old female patient, who was scheduled for a cervical biopsy operation in the Gynecology and Obstetrics clinic, developed a loss of consciousness due to lidocaine with tonic-clonic epileptic seizures during treatment with sedoanalgesia. The patient was intubated with 2 mg midazolam, 200 mg propofol and 50 mg rocuronium intravenously, while oxygen was provided by mask at 6 liters / min. Anesthesia was maintained with 4 lt / min 50% oxygen and 50% air mixture and 2% sevoflurane. There were signs of respiratory acidosis in the blood gas analysis. She was intubated for half an hour by a mechanical ventilator. The operation was canceled. In blood gas monitoring the values were within normal limits. Sugammadex was applied by the gynecology and obstetrics department. In all cases where local anesthetic is planned, necessary precautions should be taken to cope with rare complications.

A Comparative Study of the Anesthetic Efficacy, Post Tourniquet Release Analgesia and Side Effects of Ropivacaine 0.2% & Lignocaine 0.5% in Intravenous Regional Anesthesia for Hand Surgeries

A Comparative Study of the Anesthetic Efficacy, Post Tourniquet Release Analgesia and Side Effects of Ropivacaine 0.2% & Lignocaine 0.5% in Intravenous Regional Anesthesia for Hand Surgeries

The Effect of Melatonin on Anxiety and Pain of Tourniquet in Intravenous Regional Anesthesia.

Background:Melatonin has anxiolytic and potential analgesic effects. Several studies have indicated the sedative and anti-anxiety effects of melatonin when used as premedication before surgery. Hence, we assessed the efficacy of melatonin premedication in tourniquet-related pain and analgesia in patients receiving intravenous regional anesthesia (IVRA).Materials and Methods:Fifty patients undergoing elective hand surgery under IVRA were randomly divided into two groups (25 patients each) to receive either melatonin 6 mg (melatonin group) or placebo (control group) as oral premedication. IVRA was achieved with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Anxiety scores, sensory and motor block onset and recovery times, tourniquet pain, and 24-h analgesic requirements were recorded.Results:The onset of motor and sensory block was statistically significantly shorter in Group M (P < 0.001), and recovery of motor and sensory block was statistically significantly longer in Group M (P < 0.001). The time of starting tourniquet pain was longer in Group M (P < 0.001). The mean anxiety score in the study group was 3 ± 0.81 and in the control group was 4.20 ± 1.04 (P = 0.001). There was a statistically significant difference in the need for opioids between the two groups (P < 0.05).Conclusions:Melatonin is an effective premedication before IVRA because it reduces patient anxiety, decreases tourniquet-related pain, and improves perioperative analgesia.

A comparative study on the effect of dexamethasone, dexmedetomidine, and lornoxicam as adjuncts to local anesthetic in intravenous regional anesthesia in forearm and hand surgery

Background Intravenous regional anesthesia (IVRA) is a simple and reliable technique. The ideal IVRA solution should be rapid in onset and offers prolonged analgesia. The aim of this study was to assess the effects of different additives to local anesthetic in IVRA to provide a successful operative anesthesia with minimal analgesic requirements.Patients and Methods 80 patients ASA I–III scheduled for orthopedic and plastic surgeries in the forearm or the hand were randomly categorized into four groups, with 20 patients in each group. All groups received 30 ml of Lidocaine 1 % as IVRA solution in addition to the studied anesthetic adjunct.Group I (LD) received 8 mg dexamethasone in 2 mlGroup II (LP) received 0.5 mcg/kg dexmedetomidine in 2 mlGroup III (LL) received 8 mg lornoxicam in 2 mlGroup IV (LS) received 2 ml normal saline 0.9%Mean arterial pressure and heart rate changes in the four study group changes were noted. Motor and sensory block onset and recovery times (minutes) and postoperative analgesic (gram paracetamol) consumption in the four study groups were recorded. Incidence of tourniquet pain and operative conditions were also assessed.Results The LP group showed a shorter time to onset of sensory block than the other three groups that was statistically significant with p<0.001. Both the LP and LL groups showed statistically significant longer time to recovery of sensory block (min) than the other groups (p<0.001). Both times to onset of motor block (min) and time to recovery of motor block (min) shows statistical insignificance regarding the relation between the 4 groups (p=0.073 and 0.794 respectively). Time to 1st postoperative analgesic request (min) was significantly late and the postoperative paracetamol consumption (gm) was significantly lower in the LP and LL groups than the other groups (p<0.001).Conclusion On studying different additives to lidocaine in IVRA, we found that dexmedetomedine and lornoxicam provide the best patient outcome regarding the onset and recovery of sensory block and prolonged analgesia.

Efficacy of paracetamol when added as an adjunct to lignocaine in intravenous regional anaesthesia- A prospective randomised double blinded study

Efficacy of paracetamol when added as an adjunct to lignocaine in intravenous regional anaesthesia- A prospective randomised double blinded study

Fentanyl versus dexmedetomidine as adjuvants to lignocaine in intravenous regional anesthesia

Background and objectives Intravenous regional anesthesia (IVRA) is a safe, simple, and inexpensive technique compared with general anesthesia for upper and lower limb surgeries. It also provides a bloodless area during surgery. Various adjuvants have tried to fasten the onset, prolong the duration of the block, and to increase postoperative analgesia. We compared fentanyl and dexmedetomidine as adjuvants to lignocaine for IVRA for upper limb surgeries. Patients and methods After the approval of the ethics committee of the institution, 64 patients of both sexes who were scheduled for optional hand or forearm surgery were divided into two groups (32 patients in each group); 32 patients received a 20 ml lignocaine 1%+1 µg/kg fentanyl in 5 ml supplemented with normal saline 0.9% (LF group) and 32 patients received 20 ml of lignocaine 1%+1 µg/kg dexmedetomidine in 5 ml supplemented with normal saline 0.9% (LD group). The following parameters were observed: blood dynamics, the time of the start of sensory and motor blockade, the need for analgesia during the operation, the time for first postoperative analgesia, and side effects between groups. Results There was a significant reduction in sensory and motor block onset in the fentanyl group compared with the dexmedetomidine group (P 0.05) in relation to the need for analgesia during the procedure. The results showed that patients in the LF group were more satisfied than the LD group (P 0.05). Conclusion We conclude that adding 1 μg/kg dexmedetomidine or 1 μg/kg fentanyl to lignocaine for IVRA improves the quality of anesthesia and perioperative analgesia without causing complications. We found that fentanyl reduces the time for onset of block and provided better patient satisfaction than dexmedetomidine although it scored the highest sedation score.

Addition of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Intravenous Regional Anesthesia

Addition of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Intravenous Regional Anesthesia

Peripheral opioid receptor mediated enhancement of analgesia by buprenorphine in intravenous regional anaesthesia

Peripheral opioid receptor mediated enhancement of analgesia by buprenorphine in intravenous regional anaesthesia

Study of post-operative analgesia after addition of opioids with intravenous regional anesthesia

Study of post-operative analgesia after addition of opioids with intravenous regional anesthesia

Application of the traditional intravenous regional anaesthesia (IVRA) method with the help of an under-knee tourniquet for short-term foot and ankle surgeries.

Application of the traditional intravenous regional anaesthesia (IVRA) method with the help of an under-knee tourniquet for short-term foot and ankle surgeries.