Lidocaine For Intravenous Regional Anesthesia Research Articles

Efficacy and Safety of Adding Ketamine to Lidocaine in Intravenous Regional Anesthesia: A Meta-analysis of Randomized Controlled Trials

PurposeTo systematically evaluate the efficacy and safety of adding ketamine (K) to lidocaine (L) for intravenous regional anesthesia (IVRA). DesignA systematic review and meta-analysis. MethodsA comprehensive search of the Cochrane library, Embase, PubMed, Web of Science, and ProQuest databases, and the Google Scholar search engine was conducted from inception to March 2023. All retrieved articles were imported into Endnote X20 software and independently screened by two researchers according to predetermined inclusion and exclusion criteria. The data were analyzed using Revman 5.4 software and the assessed outcomes included the time of sensory and motor block onset, time of sensory and motor block recovery, fentanyl consumption, time of tourniquet pain onset, intraoperative and postoperative visual analog scale scores, and complications. FindingsA total of 532 patients from 11 randomized controlled trials were included in the meta-analysis. The results showed that the time of sensory (P < .00001) and motor block onset (P < .00001) were shorter in the L + K group than in the L-only group. The time of sensory (P = .01) and motor block recovery (P = .006) and time of tourniquet pain onset (P < .00001) were longer in the L + K group than in the L-only group. There was a significant reduction in fentanyl consumption (P = .0002) in the L + K group compared to the L-only group. Moreover, the visual analog scale scores in the L + K group were significantly lower than the L-only group 10 minutes (P = .04), 20 minutes (P = .0004), 30 minutes (P < .00001), and 40 minutes (P < .0001) after tourniquet inflation, and 5 minutes (P < .00001), 15 minutes (P = .04), 30 minutes (P = .008), 1 hour (P = .002), 2 hours (P < .00001), and 4 hours (P < .00001) after tourniquet deflation. There was no evidence that the use of K as an adjuvant in IVRA increased adverse effects. ConclusionsThe addition of K to L in IVRA shortened the onset time, prolonged the block time, and reduced intraoperative and postoperative pain without increasing complications.

Dexmedetomidine Prolongs Lidocaine Intravenous Regional Anesthesia in Rats by Blocking the Hyperpolarization-Activated Cation Current.

Intravenous regional anesthesia (IVRA) using lidocaine provides effective localized analgesia but its duration is limited. The mechanism by which dexmedetomidine enhances lidocaine IVRA is unclear but may involve modulation of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. Lidocaine IVRA with varying dexmedetomidine concentrations was performed in the tails of Sprague-Dawley rats. Tail-flick and tail-clamping tests assessed IVRA analgesia and anesthesia efficacy and duration. Contributions of α2 adrenergic receptors and HCN channels were evaluated by incorporating an α adrenergic receptor antagonist, the HCN channel inhibitor ZD7288, and the HCN channel agonist forskolin. Furthermore, whole-cell patch clamp electrophysiology quantified the effects of dexmedetomidine on HCN channels mediating hyperpolarization-activated cation current (Ih) in isolated dorsal root ganglion neurons. Dexmedetomidine dose-dependently extended lidocaine IVRA duration and analgesia, unaffected by α2 receptor blockade. The HCN channel inhibitor ZD7288 also prolonged lidocaine IVRA effects, while the HCN channel activator forskolin shortened effects. In dorsal root ganglion neurons, dexmedetomidine concentration-dependently inhibited Ih amplitude and shifted the voltage-dependence of HCN channel activation. Dexmedetomidine prolongs lidocaine IVRA duration by directly inhibiting HCN channel activity, independent of α2 adrenergic receptor activation. This HCN channel inhibition represents a novel mechanism underlying the anesthetic and analgesic adjuvant effects of dexmedetomidine in IVRA.

Regional versus systemic dexmedetomidine as an adjuvant to lidocaine for intravenous regional anaesthesia in healthy volunteers: a randomized crossover study

Background Dexmedetomidine enhances the quality and duration of lidocaine intravenous regional anaesthesia (IVRA). However, the two administration routes have not been directly compared regarding effects on tourniquet tolerance time with lidocaine IVRA. Additionally, it remains unclear whether the prolonged tourniquet tolerance stems from the direct peripheral action of dexmedetomidine or indirect systemic analgesic effects. Methods We conducted forearm IVRA in 12 healthy volunteers using a crossover design on two separate study days. One day, the systemic dexmedetomidine group received an intravenous infusion of 0.5 μg/kg dexmedetomidine (20 mL) in one arm, followed by 0.5% lidocaine (25 mL) forearm IVRA in the contralateral arm. On the other day, the regional dexmedetomidine group received an intravenous 0.9% saline infusion (20 mL) in one arm, followed by combined 0.5% lidocaine (25 mL) and 0.5 μg/kg dexmedetomidine forearm IVRA in the opposite arm. After a two-week washout period, participants crossed over to receive the alternate treatment. The primary outcome was tourniquet tolerance time, from initiating IVRA until the patient-reported tourniquet pain numerical rating scale exceeded three. Results The tourniquet tolerance time was longer with regional versus systemic dexmedetomidine (36.9 ± 7.6 min vs 23.3 ± 6.2 min, respectively), with a 13.6 min mean difference (95% CI: 10.8 to 16.4 min, p < 0.001). Regional dexmedetomidine also hastened sensory onset and extended sensory recovery compared to systemic administration. Delayed sedation after tourniquet release occurred in 5 of 12 subjects receiving regional dexmedetomidine. Conclusion The addition of regional dexmedetomidine to lidocaine prolonged tourniquet tolerance time in forearm IVRA to a greater extent compared to systemic dexmedetomidine in healthy volunteers. Trial registration Chinese Clinical Trial Registry, ChiCTR2300067978.

A sequential allocation study to determine the ED50 of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia

BackgroundIntravenous regional anesthesia is an easy and reliable anesthetic technique, but its use is limited by tourniquet pain. Clonidine is effective in overcoming this shortcoming when used with intravenous regional anesthesia at a dose of 1 μg/kg. Dexmedetomidine has also been used successfully at a dose of 0.5 μg/kg.ObjectiveBased on the potency ratios of clonidine and dexmedetomidine (8 to 1) we hypothesize that a lower dexmedetomidine dose would provide patients with 50 min of pain free tourniquet time.MethodsAfter informed consent, patients received intravenous regional anesthesia with lidocaine and dexmedetomidine following a sequential allocation scheme. The first patient received a dose of 0.5 μg/kg of dexmedetomidine. The dose was then adjusted in 0.1 μg/kg gradients for the following patients depending on the success of the previous block. If a patient experienced tourniquet pain prior to 50 min, the next patient received a higher dose. If not, the dose was decreased. Recruitment continued until 6 independent crossovers were observed with a minimum of 20 patients. The median effective dose ED50 of dexmedetomidine was calculated using the modified up-and-down method.Main outcome measuresThe median effective dose of dexmedetomidine (ED50) that provides 50 min of tolerance to the tourniquet during a lidocaine intravenous regional anesthesia by a sequential Dixon up-and-down allocation study.ResultsThe ED50 of dexmedetomidine that provided 50 min of tolerance to the tourniquet was 0.30 ± 0.06 μg/kg.ConclusionWe determined that the dexmedetomidine dose necessary to provide 50 min of pain free tourniquet time during intravenous regional anesthesia was higher than expected based on the relative alpha-2 adrenergic receptor selectivity of dexmedetomidine compared to clonidine.Trial registrationClinicaltrials.gov: Retrospectively registered (NCT05342870; registration date: 25/04/2022).

Lidocaine Plus Morphine Versus Lidocaine Plus Paracetamol for Bier Block: A Double-Blind Randomized Controlled Trial

PurposeIntravenous regional anesthesia (Bier block) is widely used as an anesthetic technique for operations of short duration of the distal upper or lower extremities. We compared the efficacy of intravenous regional anesthesia with lidocaine plus paracetamol versus lidocaine plus systemic morphine for short-duration hand and forearm surgeries. DesignA double-blind randomized controlled trial with two parallel arms: lidocaine plus morphine (control) and lidocaine plus paracetamol were carried out at a University hospital. MethodsWe included men and women aged 20 to 70 years scheduled for short surgical procedures (30-60 minutes) distal to the elbow. Intravenous regional anesthesia was carried out by injecting 45 cc lidocaine 0.5% plus 300 mg paracetamol for the paracetamol group; or 45 cc lidocaine 0.5% plus 4 mg intravenous morphine for the control group. The primary outcome was postoperative pain-free period in minutes since deflation of proximal tourniquet. The secondary outcome was the highest intensity of postoperative pain on the visual analog scale within 2 hours after deflating the proximal tourniquet. FindingsThere was no significant difference between morphine and paracetamol in the duration of postoperative pain-free period (P = .078) and the mean intensity for maximum pain (P = .106). However, severe pain was significantly more frequent in the morphine group (P = .001). Paracetamol seemed to be safer than morphine as an adjuvant to lidocaine. ConclusionsWe recommend using 2 cc paracetamol (300 mg Apotel) as the adjuvant to lidocaine for intravenous regional anesthesia.

Magnesium Sulfate versus Tramadol as Adjuvants to Lidocaine in Intravenous Regional Anesthesia for Carpal Tunnel Release Surgery: A Randomized Clinical Study

Intravenous regional anesthesia [IVRA] is a simple and effective anesthetic method for providing regional anesthesia of the upper limbs during carpal tunnel release surgery [CTRS]. However, the procedure is associated with significant postoperative pain and adjuvant analgesic agents are recommended.

Ketorolac versus paracetamol adjunct to lidocaine for intravenous regional anesthesia in patients undergoing hand and forearm surgeries

Ketorolac versus paracetamol adjunct to lidocaine for intravenous regional anesthesia in patients undergoing hand and forearm surgeries

Analgesic Effect Of Paracetamol As An Adjuvant To Lidocaine For Intravenous Regional Anaesthesia: A Prospective Randomized Study

Background: Intravenous Regional Anaesthesia (IVRA) also known as Biers block is a procedure used to provide regional block in both the upper and lower extremities. This study aims to determine the effects of adding paracetamol to lidocaine for intravenous regional anaesthesia (IVRA). Methods: Forty eligible patients undergoing short upper limb surgery received IVRA were assigned to two groups (n = 20 each): Group X: received lidocaine (3 mg/kg) diluted with normal saline and paracetamol 450 mg to a volume of 40 ml. Group Y: received lidocaine (3 mg/kg) diluted with normal saline a to a volume of 40 ml. Variables measured were: sensory onset and recovery time, visual analogue scale (VAS) scores; intraoperative and at 6 hours postoperatively, tourniquet pain and time to first analgesic requirement. Results: Sensory block onset time among group X was significantly shorter than group Y p= statistically significant. Durations of Sensory block in group X was also significantly longer than group Y p= statistically significant. Twenty minute intraoperatively till 60 minutes, VAS was significantly higher in group Y which required majority 68.4% to receive a single dose of intraoperative fentanyl analgesia compared to 27.6% among Group X. Postoperative VAS was lower among Group X from 2nd -5th hours compared to group Y, p= statistically significant. Similarly, time to first postoperative analgesic requirement was significantly longer in Group X p= statistically significant than group Y. Conclusion: Addition of paracetamol to Lidocaine for IVRA improves quality of analgesia and reduce intra and postoperative analgesic requirement.

The Analgesic Effect of Dexketoprofen Trometamol When Added to Lidocaine for Intravenous Regional Anesthesia

Aim: The purpose of this study was to evaluate the duration of onset and regression time of sensory and motor blocks, tourniquet pain, and postoperative analgesia with the addition of dexketoprofen trometamol to lidocaine solution in intravenous regional anesthesia (IVRA) for hand surgery. Material and Methods: This study was designed as a retrospective analysis. Records, including perioperative anesthesia notes, of 290 patients evaluated and 75 identified as eligible that underwent IVRA with an upper extremity Bier block and a corresponding tourniquet time of less than 1 hour were reviewed. Patients undergoing IVRA with lidocaine (3 mg/kg) were compared with those receiving dexketoprofen trometamol (50 mg) as an adjuvant in IVRA (the D-IVRA group) or as intravenous analgesia in the non-operated arm (the D-IV group) . All hemodynamic values, sensorial/motor block onset and regression times, VAS values, intraoperative and postoperative analgesic requirements, and all complications were recorded. Results: Sensory block onset time was shorter and motor block regression time longer in the D-IVRA group. After tourniquet deflation, all perioperative VAS scores in the D-IVRA group were lower than those of the control group. VAS scores were lower in the D-IVRA group compared to the D-IV group, especially at 30 min and 1 h postoperatively.Conclusion: The addition of dexketoprofen trometamol to lidocaine in IVRA may increase the quality of anesthesia and analgesia in hand surgery.

Sequential analysis for median effective dose of Dexmedetomidine in upper limb Lidocaine intravenous regional anesthesia

ABSTRACT Background Auxiliary drugs augment the effect of local anesthetic in intravenous regional anesthesia (IVRA). The aim of our study was to estimate the median effective dose (ED50) of Dexmedetomidine in elective upper limb Lidocaine 0.5% IVRA. Method A prospective, double-blind, sequential study using modified Dixon’s up and down method. Thirty patients scheduled for minor upper limb surgeries were recruited in the Study, however, we ended up analyzing data of 26 patients due to protocol violation. The first patient in this sequential trial was randomly selected and received a mixed solution of 0.5% lidocaine and 0.4 µg/kg of dexmedetomidine, with 0.1 µg/kg dose interval. If IVRA outcome was satisfactory, the dose went down for the next patient by 0.1 µg/kg. Vice versa, if the outcome was unsatisfactory, the dexmedetomidine dose was stepped up by 0.1 µg/kg. Sensory and motor block onset, recovery times, hemodynamic variables, surgical and tourniquet VAS scores and time to first analgesic request were recorded. Results The series of patient responses to IVRA was satisfactory in 11 patients (42.3%) and unsatisfactory in 15 patients (57.6%) due to either surgical pain in 6 patients or tourniquet pain in the remaining 9 patients. In patients with satisfactory response to IVRA, intraoperative and postoperative mean arterial pressure and heart rate, compared with baseline (just prior to inflating the proximal cuff) measurement, showed no statistically significant differences (P = 0.754 and 0.324, respectively). Intergroup comparison of Patients with unsatisfactory response to IVRA time to first analgesic request showed no statistical difference (P > 0.05). Conclusion the ED 50 of Dexmedetomidine (95% confidence interval, CI) as adjuvant for satisfactory 0.5% lidocaine IVRA was 0.7 µg/kg (0.6–0.8).

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.

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.

Comparative Study between Naloxone as an Additive to Lidocaine and Naloxone Infusion in Intravenous Regional Anaesthesia for Short Procedures of Upper Limb Surgeries

Background: intravenous regional anesthesia (IVRA) was first described by August Bier in 1908. IVRA is an anesthetic technique for surgical procedures on the body's extremities where a local anesthetic is injected intravenously. The local anesthetic diffuses from the peripheral vascular bed to nonvascular tissue such as axons and nerve endings. Objective: The aim of the present study was to compare the effect of adding ultra-low dose of naloxone to lidocaine for IVRA and the effect of using intravenous naloxone infusion with IVRA for elective short procedures in the upper limb. Patients and Methods: This is Prospective; randomized, controlled, multicenter, double blind study that done in Alazhar University hospitals. Each group contains 30 patients. The lidocaine in the study is 2% 3mg/kg in all groups. In all groups 0.9% NaCl is added to make up a total volume of 30 ml. Results: The result of our study showed that local intravenous adjuvant naloxone (100 or 50ng) with lidocaine 1 % shortens the onset of blocks and prolongs the recovery from anesthesia. Moreover, it reduces the amount of opioids consumption and intraoperative pain score in patient undergoing short upper limb surgeries. Conclusion: Naloxone IV infusion not improves the analgesic effect of intravenous anesthesia or prolongs the recovery from anesthesia. Regarding safety, adjuvant naloxone appears to be safe with no recorded side effects.

Comparative Study between Naloxone as an Additive to Lidocaine and Naloxone Infusion in Intravenous Regional Anaesthesia for Short Procedures of Upper Limb Surgeries

Background: intravenous regional anesthesia (IVRA) was first described by August Bier in 1908. IVRA is an anesthetic technique for surgical procedures on the body's extremities where a local anesthetic is injected intravenously. The local anesthetic diffuses from the peripheral vascular bed to nonvascular tissue such as axons and nerve endings. Objective: The aim of the present study was to compare the effect of adding ultra-low dose of naloxone to lidocaine for IVRA and the effect of using intravenous naloxone infusion with IVRA for elective short procedures in the upper limb. Patients and Methods: This is Prospective; randomized, controlled, multicenter, double blind study that done in Alazhar University hospitals. Each group contains 30 patients. The lidocaine in the study is 2% 3mg/kg in all groups. In all groups 0.9% NaCl is added to make up a total volume of 30 ml. Results: The result of our study showed that local intravenous adjuvant naloxone (100 or 50ng) with lidocaine 1 % shortens the onset of blocks and prolongs the recovery from anesthesia. Moreover, it reduces the amount of opioids consumption and intraoperative pain score in patient undergoing short upper limb surgeries. Conclusion: Naloxone IV infusion not improves the analgesic effect of intravenous anesthesia or prolongs the recovery from anesthesia. Regarding safety, adjuvant naloxone appears to be safe with no recorded side effects.

Transdermal Nitroglycerin Enhances Lidocaine And Neostigmine for Intravenous Anesthesia in Patients Undergoing Hand Surgery. A Prospective Randomized Double Blind Placebo Control Study.

In a prospective randomized blind study, we investigated the effects of adding transdermal nitroglycerine for lidocaine and neostigmine for intravenous regional anesthesia in adult patients undergoing hand surgery. Patients and Methods Sixty patients (ASA grade I, aged 20-60 years) of both sexes were enrolled. The patients were randomly allocated to receive either 40ml of 0.5% lidocaine plus a transdermal placebo patch (control group n=15), 40ml of 0.5% lidocaine with 0.5mg of neostigmine plus a transdermal placebo patch (Neostigmine group, n=15), 40ml of 0.8% lidocaine plus a transdermal nitroglycerine patch (Nitroglycerine group, n=15) or 40ml of 0.5% lidocaine with 0.5mg of neostigmine plus a transdermal nitroglycerine patch (Neostigmine - Nitroglycerine group, n=15). All routine hemodynamic parameters and O2 saturation were monitored, surgical time, sensory and motor block onset times, sensory and motor block recovery times and time to first analgesic requirement were measured. Operative conditions and quality of anesthesia were also recorded. Results Sensory and motor block onset times were shorter in the neostigmine – nitroglycerine group compared with all other groups (p<0.05). Sensory block recovery time was significantly prolonged and the quality of anesthesia was better in the neostigmine – nitroglycerine group compared with all other groups (p<0.05). Conclusion We found that the addition of 0.5mg neostigmine to 40ml of 0.5% lidocaine for intravenous regional anesthesia with a 5mg transdermal nitroglycerine patch improved the operating conditions and quality of anesthesia and prolonged postoperative relief with no adverse effects.

Ketorolac versus Magnesium Sulphate as an Adjuvant to Lidocaine in Intravenous Regional Anesthesia for Upper Limb Surgeries

Background: intravenous regional anesthesia (IVRA) was first described almost a century ago by August Bier and has been used for the past 50 years. It is a safe anesthetic technique for upper or lower distal limb surgery. Purpose: to compare the onset time of sensory blockade when adding ketorolac versus adding magnesium to the IVRA solution, and to compare the duration of postoperative analgesia. Material and Methods: this is a randomized controlled trial in two groups. The study was performed in Ain Shams University Hospitals. Study period range was 1-2 years. Results: there are 146 patients participated in our study, patients were allocated to two groups 73 patients in each group, a group of which received magnesium sulphate solution and the other received ketorolac solution. Conclusion: we evaluated the effects of adding ketorolac and compared it to the effects of adding magnesium sulphate to the anesthetic solution used in IVRA and we found that magnesium sulphate addition can be of benefit in faster onset of sensory block in the operative limb. However, magnesium sulphate in the used concentration (10 ml MgSo4 10% in 40 ml solution) appeared to cause burning pain varying in intensity while injecting the anesthetic solution.

Ketamine Plus Nitroglycerin Versus Ketamine as Adjuncts to Lidocaine for Intravenous Regional Anesthesia in Adult Patients Undergoing Hand Surgery

Background: Different agents have been used as adjutants to lidocaine for intravenous regional anesthesia (IVRA) to improve the quality of analgesia. Objective: The aim of this double blinded randomized controlled trial is to evaluate if adding nitroglycerin to ketamine is more effective than using ketamine alone as an adjuvant to lidocaine for IVRA. Methods: Fifty adult ASA I-II patients undergoing hand surgery using IVRA were divided into two equal groups: ketamine/nitroglycerin (K/N) group received lidocaine 3mg/kg (maximum 200 mg) with ketamine 0.1 mg/kg (maximum 10 mg) plus nitroglycerin 2 mcg/kg (maximum 200 mcg) and ketamine (K) group received lidocaine 3 mg/kg (maximum 200 mg) with ketamine 0.1 mg/kg (maximum 10 mg). Statistical analysis was done using Student's t test or Chi square analysis whenever appropriate. Results: The two groups were similar in demographic data and patients characteristics. The onset times of sensory and motor blockades were significantly shorter in K/N group. Although the preoperative visual analogue scale for pain intensity (VAS) was comparable, the intra-operative and postoperative VAS, were significantly less in K/N group. The intra-operative fentanyl consumption as an intra-operative analgesia was significantly less in K/N group. Also, the time to call for the first postoperative analgesia was significantly longer in K/N group than K group. However the postoperative analgesics consumption showed no significant difference between the two groups. Conclusion: In comparison to ketamine, adding a combination of ketamine and nitroglycerin to lidocaine for IVRA improved the quality of anesthesia without inducing significant clinical side effects. Key words: Nitroglycerin, ketamine, intravenous, regional, anesthesia.

A Comparative Study between Dexmedetomidine 1 µg/kg and and 25mg/ kg of 50% Magnesium Sulphate as Adjuvants with 0.5% Lidocaine for Intravenous Regional Anaesthesia

A Comparative Study between Dexmedetomidine 1 µg/kg and and 25mg/ kg of 50% Magnesium Sulphate as Adjuvants with 0.5% Lidocaine for Intravenous Regional Anaesthesia

ADDITION OF PANCURONIUM AND NITROGLYCERIN TO LIDOCAINE FOR INTRAVENOUS REGIONAL ANESTHESIA IN UPPER EXTREMITY SURGERY: BLOCK CHARACTERISTICS AND POSTOPERATIVE ANALGESIA

Background: Intravenous regional anesthesia (IVRA) provides reliable and rapid analgesia with good muscle relaxation of the extremity distal to the tourniquet, but tourniquet pain and absence of post-operative analgesia are major drawbacks. Nitroglycerine and muscle relaxants are known to potentiate peripheral nerve blocks. Objective: Comparing nitroglycerine and pancuronium as adjuvants to IVRA with respect, block characteristics, and post- operative analgesia. Patient and Methods: This study was carried out in Al- Azhar University Hospitals for 6 months ( from 1/4/2016 to 1/10/2016 ) on 60 patients of both sexes aged 20-50 years, and belonging to ASA I & II undergoing forearm and hand surgeries. Patients were randomely divided into three equal groups ( 20 patients at each group ) . Group I received 40 cc of 3 mg/kg of lidocaine diluted in normal saline (0.9 % NaCl), Group II recieved 40 cc of 1.5 mg/kg of lidocaine diluted in normal saline (0.9% NaCl) with 200 µg nitroglycerine, and Group III received 40 cc of 1.5 mg/kg of lidocaine diluted in normal saline (0.9 % NaCl with 200 µg nitroglycerin and 0.5 mg pancuronium. Results: Group I has the slowest sensory and motor onset time, but the shortest sensory and motor recovery time. There was no significant difference between Group II and III as regarding sensory onset and recovery times, but Group III has shoter motor onset time and more prolonged motor recovery time than Group II. As regard postoperative analgesic requirements, Group II and III needed less analgesic doses than Group I, but there was no significant difference between Group II and III. Conclusion: Addition of 0.5 mg pancuronium and 200 µg nitroglycerin as adjuvant to lidocaine for intravenous regional anesthesia reduced the dose of lidocaine used for IVRA, shortened the sensory and motor block onset times, prolonged the sensory and motor block recovery times, and reduced the postoperative analgesic requirement and improved the quality of intravenous regional anesthesia with no side effects.