Lidocaine For Intravenous Regional Anesthesia Research Articles

Analgesic effects of ketorolac/lidocaine compared to dexmedetomidine/lidocaine in intravenous regional anesthesia

Introduction: Intravenous regional anesthesia is known as a safe and reliable technique for anesthesia and reduction of bleeding during limb surgeries. The aim of this study is to compare the addition of ketorolac or dexmedetomidine to lidocaine in intravenous regional anesthesia. Materials and Methods: In this double-blind clinical trial, ninety patients who were admitted for surgery on hand or forearm in Vali-Asr Hospital, Arak city, entered the study. Then, the patients divided into three equal groups. The first group received 3 mg/kg lidocaine 0.5%, the second group received 1 μg/kg dexmedetomidine with lidocaine, and the third group received 30 mg ketorolac with lidocaine. The time to analgesia, pain during surgery, onset of pain after tourniquet deflation, and the pain after tourniquet deflation were measured. Results: The mean duration to analgesia was 7.37 ± 0.67 min in control group, 5.23 ± 0.68 min in dexmedetomidine group, and 4.90 ± 0.76 min in ketorolac group (P = 0.164). In total of 3 times of measurement of pain after injection, the mean visual analog scale in ketorolac group was significantly lower than lidocaine (P = 0.0001) and dexmedetomidine (P = 0.009) groups. In all time intervals after tourniquet deflation, the mean score of pain was significantly lower in ketorolac group. Conclusion: Ketorolac could control the perioperative pain and the pain after tourniquet deflation. It seems that ketorolac is a useful and effective choice for pain relief for patients undergoing intravenous regional anesthesia.

The Efficacy of Adding Lornoxicam-Dexmedetomidine to 0.25% Diluted Lidocaine for Intravenous Regional Anesthesia

Background and objective: Upper limb surgeries under Intravenous regional anesthesia (IVRA) with the traditional dose of lidocaine may lead to side effects incompatible with life safety. Anesthetists attempted many modified techniques of IVRA to use a lesser dose of lidocaine combined with some adjuvants to avoid these side effects. Aim and work: The primary outcome was to compare the first analgesic requirement time of when adding lornoxicam and dexmedetomidine to lidocaine IVRA in outpatients who underwent upper limb surgery, and the secondary outcomes were to compare the onset of sensory and motor blocks, the tourniquet pain and the sensory and motor block recovery times at postoperative period. Patient and methods: Patients were randomly into two groups each group with 50 patients. Group I (G I) were given solely 3 mg/kg of 0.5% lidocaine diluted with normal saline in a volume of 40 ml. Group II (GII) were given 1.5 mg/kg of 0.25% lidocaine plus 8 mg of lornoxicam and 0.5 μg/kg dexmedetomidine all diluted with normal saline in a total volume of 40 ml. Numerical Rating Score (NRS) was used to assess the sensory block. Motor blockade assessment was done by Modified Bromage Scale Tourniquet pain was noted by using the Numeric rating scale (NRS) before tourniquet inflation (BT), 5 min after tourniquet inflation, tourniquet inflation, every 10 min after tourniquet inflation, at tourniquet release, after 30 min, 2 h, and 4 h of tourniquet release. Results: Sensory and motor block onset times (min) were significantly delayed in group II than in group I (p=0.001). Sensory and motor recovery times after release of tourniquet (min) after release of tourniquet (min) were more prolonged in group II than in group I (p=0.001). Significant differences in the number of patients who had tourniquet pain as more patients in group I showed tourniquet pain (p=0.007), Time of onset of tourniquet pain (min ) and the first analgesia requiring time after release of tourniquet were significantly delayed in group II than in group I (p=0.001), While the total intraoperative fentanyl requirement (μg) was significantly lower in group II than in group I(p=0.001). More patients developed postoperative complications in group I than in group II, but this was not statistically significant (p>0.05). Conclusion: Adding lornoxicam-dexmedetomidine to 0.25% lidocaine in comparison with 0.5% lidocaine for IVRA alone causes a short delay in the onset and the attainment of complete sensory and motor blocks; however this safe and effective combination can be used in IVRA for upper limb surgeries with better analgesic effect and lesser probability of local anesthetic toxicity.

Effects of transdermal nitroglycerin and intravenous pancuronium added to lidocaine for intravenous regional anesthesia

Objective The aim of this study was to evaluate the effects of transdermal nitroglycerin patch, pancuronium, or a combination of both when added to low-dose lidocaine compared with standard-dose lidocaine alone in the intravenous regional anesthesia (IVRA) technique in adult healthy participants. Background Administration of neuromuscular blocking agents or nitroglycerin with local anesthetics in the upper limb during IVRA improves surgical conditions in adults. Patients and methods A total of 100 patients of both sexes aged 18 years or older undergoing elective forearm and hand surgeries were divided into four groups: group A received only lidocaine, group B received lidocaine + pancuronium, group C received lidocaine + nitroglycerin patch, and group D received lidocaine + pancuronium + nitroglycerin patch. Sensory and motor block onset and recovery times, Visual Analog Scale for Pain (VAS scores) for tourniquet pain, postoperative VAS score, and analgesic requirements were recorded. Results Sensory block onset times were shorter in groups D and C. Motor block onset times were shorter in groups D and B. Sensory block recovery time prolonged in group D. Motor block recovery time was prolonged in group D. There was a significant difference between the four groups in intraoperative pethidine requirements. The lowest dose of pethidine needed was in group D. Postoperative VAS scores showed significant differences between groups. Postoperative analgesic effect was the longest in group D. Conclusion A combination of 0.5 mg of pancuronium and 5 mg of transdermal nitroglycerin patch as adjuvant to 1.5 mg/kg lidocaine 0.25% improves the quality of IVRA without any side effects.

Comparative study of midazolam, dexmedetomidine, and ketamine as an adjuvant to lidocaine in intravenous regional anesthesia for forearm and hand surgeries

Background Intravenous regional anesthesia (IVRA) is an ideal method of providing anesthesia for minor surgical procedures to the extremities performed on an ambulatory basis. This study aimed to study the effects of adding midazolam, dexmedetomidine, or ketamine as an adjuvant to lidocaine in IVRA during forearm and hand surgeries and examine their benefits and complications. Patients and methods A total of 120 patients were included, aged 40–60 years (American Society of Anesthesiologists physical status I–II), undergoing hand and forearm, from April 2015 to August 2016. Patients were randomly divided into four equal groups. Lidocaine-only group (LL group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg). Lidocaine plus midazolam group (LM group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus midazolam 50 µg/kg added as an adjuvant. Lidocaine plus dexmedetomidine group (LD group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus dexmedetomidine 1 µg/kg added as an adjuvant. Lidocaine plus ketamine group (LK group) received IVRA using 40 ml of lidocaine 0.5% (3 mg/kg) plus ketamine 0.5 mg/kg added as an adjuvant. The time of onset, duration, and quality of analgesia; levels of sensory and motor block; heart rate; mean arterial blood pressure; and visual analog score were recorded. Adverse effects of hematoma, injection pain, skin erythema, sedation, and hallucinations were recorded. Results The onset time of sensory and motor blocks was significantly shorter in the adjuvant groups LM, LD, LK in comparison with the control group LL. The grade of sensory and motor blocks was significantly better in groups LM, LD, and LK in comparison with the LL group. The onset time of tourniquet pain was significantly shorter in the control group LL in comparison with adjuvant groups LM, LD, and LK. There was a significant increase in fentanyl requirements in the control LL group compared with adjuvant LM, LD, and LK groups. The duration of postoperative analgesia was significantly prolonged in adjuvant groups LM, LD, and LK compared with the control LL group. Hematoma, injection pain, cutaneous erythema, and hallucination were reported as postoperative complications. Conclusion The addition of midazolam, dexmedetomidine, or ketamine to lidocaine for IVRA improved the quality of intraoperative and postoperative analgesia with minimal adverse effects and higher patients and surgeon satisfaction.

Addition of Dexmedetomidine to Low Dose Solution of Lidocaine for Intravenous Regional Anesthesia A Randomized Study

Background and Aims: Intravenous Regional Anesthesia (IVRA) provides analgesia of distal part of limb by intravenous injection of local anesthesia in to the vein of the same limb, while the circulation to the limb is occluded by application of tourniquet. However, IVRAis limited by local anesthesia toxicity, tourniquet pain and absence of postoperative analgesia. Various additives to local anesthetics such as ketamine, clonidine, opiods, NSAIDs are used to address these issues. The aim of our study was to evaluate the effectiveness of Dexmedetomidine to low dose Lidocaine solution for IVRA.Patients and Methods: A prospective, randomized double blind study was conducted on 60 patients divided in to two groups of thirty each; Group I patients received 40 ml of Lidocaine 0.25% while Group II patients received 40 ml of 0.25% of lidocaine mixed with I mcg/kg of dexmedetomidine. The motor and sensory block onset and recovery times were assessed. Tourniquet pain and sedation score were assessed intraoperatively and postoperatively.Results: Sensory and motor block onset times were shorter and recovery times were prolonged in Dexmedetomidine group. The quality of anesthesia was better in the Dexmedetomidine group and the fentanyl dose required was also lower in the dexmedetomidine group. There was a significant difference in the postoperative analgesia time which was demonstrated by less use of intramuscular diclofenac in dexmedetomidine group.Conclusions: A safe intravenous dose of lidocaine can be used for IVRA for superficial hand surgery, and the addition of I mcg /kg dexmedetomidine shortened the onset times for both sensory and motor blockade and improved the quality of anesthesia, with prolonged postoperative analgesia time. By adding dexmedetomidine we were able to reduce the dose of lidocaine to 0.25% concentration without compromising analgesia. JMS 2016; 19(1):21-25

A randomized controlled study of the effects of adding ultra-low dose naloxone to lidocaine for intravenous regional anesthesia

ObjectiveThis study was designed to evaluate the effect of adding ultra-low dose of naloxone as an adjuvant to lidocaine for intravenous regional anesthesia (IVRA).MethodForty patients undergoing elective short procedures in the upper limb were randomly and blindly divided into two groups of twenty patients each. Group L (n = 20) received 3 mg/kg of 2% lidocaine diluted with normal saline to 30 ml. Group LN (n = 20) received 3 mg/kg of 2% lidocaine and naloxone 100 ng (1 ml) diluted with normal saline to 30 ml. Onset and recovery time of sensory and motor block, intraoperative and post-operative pain were measured by visual analog score (VAS), and also intraoperative analgesic requirement, time of first requirement of diclofenac postoperatively, total amount of diclofenac needed in 24 h, patient’s satisfaction and surgeon’s satisfaction scores were measured.ResultsRecovery of sensory block was significantly longer in group LN (26.7 ± 2.8 min) compared to group L (16.3 ± 0.6 min); p value (0.000). Also the recovery of motor block was significantly longer in group LN (19.1 ± 1.0 min) compared to group L (17.9 ± 1.2 min), p value (0.002). Intraoperative fentanyl requirement was significantly less in group LN (15.8 ± 5.0 mcg) compared to group L (40.0 ± 10.5 mcg), p value (0.000). 1st fentanyl requirement time was significantly longer in group LN (22.4 ± 3.1 min) than in group L (14.5 ± 6.1 min), p value (0.000). Time of first analgesic requirement post-operative was longer in group LN (78.5 ± 6.8 min) compared to group L (40.5 ± 2.0 min), p value (0.000). Total amount of diclofenac needed in 24 h was significantly less in group LN (57 ± 50 mg) compared to group L (120 ± 45 mg), p value (0.000).ConclusionThe addition of ultra-low-dose naloxone 100 ng to lidocaine for IVRA in upper limb surgery, prolonged the duration of sensory and motor block, and reduced tourniquet pain, as well as intraoperative and postoperative analgesic consumption.

Anesthetic and Analgesic Effect of Neostigmine when Added to Lidocaine in Intravenous Regional Anesthesia

Background: Intravenous regional anesthesia (IVRA) has various advantages during short surgical procedures in upper and lower limbs, but one of its disadvantages is minimal postoperative pain relief. Aim of the study: To evaluate the anesthetic and analgesic effect of adding 1 mg neostigmine to 0.5% lidocaine in IVRA. Patients and methods: This randomized double blind controlled clinical trial was carried out at Assiut University Hospital after the approval of its Ethical committee and after obtaining an informed consent from all the patients. Eighty ASA I or II patients who were scheduled for elective hand and forearm surgery were included. We excluded patients with chronic pain syndrome, Reynaud disease, sickle cell anemia, diabetes, pregnancy, lactation, drug allergy and psychological disorders. Patients were randomly assigned to control group who received 3 mg/kg 0.5% lidocaine plus 1 ml normal saline in 40 ml volume and neostigmine group who received 3 mg/kg 0.5% lidocaine plus 1 mg neostigmine in 40 ml volume. Patients were assessed for onset and recovery from the sensory and motor blocks, postoperative pain, analgesic request and incidence of complications. Results No statistically significant differences were observed between groups as regards demographic data, anesthetic or analgesic criteria or the incidence of complications . Conclusion: Addition of 1 mg neostigmine to 0.5% lidocaine in IVRA has no anesthetic or analgesic effect, and there is no increase in the incidence of complications. There are no biological facts that support its use as adjuvant to local anesthetic agents in IVRA.

Dexamethasone versus paracetamol in the augmentation of lidocaine in intravenous regional anesthesia in upper limb surgeries

Background In this study, we compare the effect of dexamethasone and paracetamol when added to intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, sensory and motor block onset times, sensory and motor recovery times, and tourniquet pain. Patients and methods Sixty adult patients undergoing elective surgical operations on the upper limb were randomly and blindly divided into three groups. All groups received IVRA lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml. Group 1 received lidocaine diluted with normal saline, group 2 received lidocaine and dexamethasone 8 mg admixture, and group 3 received lidocaine and 300 mg paracetamol. All patients were assessed as regards hemodynamics, O2 saturation, respiratory rate, intraoperative degree of analgesia, and onset of sensory anesthesia and motor block. After tourniquet deflation, time to recovery of sensory and motor block and the time to first analgesic requirement were assessed. Results The onset of sensory motor block occurred significantly earlier in group 2, followed by group 3 when compared with group 1. Patients in groups 2 and 3 tolerated tourniquet pain much better compared with group 1 patients. This led to prolonged time to first request for intraoperative analgesia and reduced the number of patients requiring fentanyl. As regards postoperative pain, patients in group 2 followed by group 3 patients tolerated the pain much better compared with group 1. This led to prolonged time to first request for analgesia. Conclusion Addition of dexamethasone to lidocaine in IVRA is superior to the addition of paracetamol.

Synergistic effects of Paracetamol and Dexamethasone with Lidocaine in Intravenous regional anesthesia (IVRA) of upper limbs: A randomized clinical trial

Background and aimPost-operative pain is considered an important complication of Intravenous regional anesthesia (IVRA) which is gaining popularity especially for surgeries on upper limbs.MethodsThe present double blind randomized clinical trial was conducted on 60 candidates of upper limb surgeries aged between 20 and 60 years who were of ASA classes 1 or 2. Subjects were randomly assigned to 4 groups: the first group was treated solely with 3 mg/kg of Lidocaine. The second and third groups received the same amount of Lidocaine plus 8 mg of Dexamethasone or 300 mg of Paracetamol respectively and for the fourth group a combination of all medications was used. For all patients, Lidocaine was diluted with normal saline until a total volume of 40 cc was reached. Onset of Sensory and motor nerve blocks, severity of post-operative pain and amount of mepridine consumption in the first 24 h after surgery were assessed.ResultsOnset of Sensory and motor nerve block was significantly accelerated in the fourth group (p < 0.01). Post-operative pain and analgesic consumption were significantly reduced in the fourth group when compared with the other groups (p < 0.05).ConclusionA combination of Paracetamol and Dexamethasone significantly enhances the analgesic effect of Lidocaine in IVRA by accelerating the establishment of both the sensory and motor nerve blocks and prolonging the period of analgesia as well as improving the quality of analgesia and reducing the need for analgesic medications during and after the operation.

A Comparative Study of 0.5% Vs 2% Lidocaine for Intravenous Regional Anaesthesia

A Comparative Study of 0.5% Vs 2% Lidocaine for Intravenous Regional Anaesthesia

Effects of Addition of Systemic Tramadol or Adjunct Tramadol to Lidocaine Used for Intravenous Regional Anesthesia in Patients Undergoing Hand Surgery.

Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA) I-II patients (n = 60) who underwent hand surgery were included. For this purpose, only lidocaine (LDC), lidocaine+adjunct tramadol (LDC+TRA group), or lidocaine+systemic tramadol (LDC+SysTRA group) was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority.

Dexmedetomidine versus ketorolac as adjuvants for intravenous regional anesthesia

Background Multiple adjuvants have been added to improve the quality of intravenous regional anesthesia (IVRA). The aim of this study was to compare the effect of dexmedetomidine with that of ketorolac as an adjuvant for lidocaine IVRA as regards the onset and duration of sensory and motor blocks, intraoperative-postoperative pain, and intraoperative and postoperative analgesic requirement. Patients and methods This study was a prospective, randomized, double-blinded trial. Sixty patients scheduled for hand or forearm surgery were randomly divided into three equal groups ( n = 20): group I was given 3 mg/kg of lidocaine 2% (maximum: 200 mg) + 0.5 μg/kg of dexmedetomidine; group II was given 3 mg/kg of lidocaine 2% (maximum: 200 mg) + 30 mg ketorolac; and group III was given 3 mg/kg of lidocaine 2% (maximum: 200 mg). In the three groups, 0.9% normal saline was added for a total volume of 40 ml. Sensory and motor block onset, recovery times, intraoperative and postoperative analgesic requirement, and hemodynamic variables were recorded and compared between the three groups. Results There was a significant reduction in sensory and motor onset, and prolonged sensory and motor duration in the dexmedetomidine group than in the ketorolac and the control group, and in the ketorolac group than in the control group ( P < 0.001). There was improved tolerance to tourniquet and postoperative pain, with low levels of intraoperative and postoperative analgesic requirement in the dexmedetomidine group than in the ketorolac group followed by the control group. Conclusion We concluded that dexmedetomidine seems to be superior to ketorolac as an adjuvant to lidocaine in IVRA in terms of tourniquet pain and intraoperative and postoperative analgesic requirements.

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

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.

Addition of dexmedetomidine to a safe intravenous dose of lidocaine for intravenous regional anesthesia

Background Intravenous regional anesthesia (IVRA) is a simple and reliable type of regional anesthesia. However, it has some limitations such as tourniquet pain, lack of postoperative analgesia, and local anesthetic toxicity in case of tourniquet malfunction. Various additives to local anesthetics, such as opioids, NSAID, ketamine, and clonidine, are used. Aim The aim of this study was to evaluate the addition of dexmedetomidine to a safe intravenous dose of lidocaine for IVRA. Patients and methods a total of 50 patients undergoing elective superficial hand surgery were assigned into two groups: the L group and the LD group. In the L group, IVRA was achieved using 2 mg/kg lidocaine 2% alone, diluted with saline to a volume of 25 ml. In the LD group, IVRA was achieved using 2 mg/kg lidocaine 2% along with 0.5 mg/kg dexmedetomidine diluted with saline to a volume of 25 ml. The motor and sensory block onset and recovery times were assessed. Tourniquet pain and sedation score were assessed intraoperatively and postoperatively. The quality of anesthesia and the duration of analgesia were also recorded. Results Sensory and motor block onset times were shorter and recovery times were prolonged in the LD group. The quality of anesthesia was better in the LD group, and the fentanyl dose required intraoperatively was also lower in the LD group. The duration of postoperative analgesia was longer and the doses of lornoxicam required were lower in the LD group. Conclusion A safe intravenous dose of lidocaine can be used for IVRA for superficial hand surgery, and the addition of 0.5 mg/kg dexmedetomidine shortened the onset times for both sensory and motor blockade and improved the quality of anesthesia, with prolonged postoperative analgesia time.

Effectiveness of ondansetron as an adjunct to lidocaine intravenous regional anesthesia on tourniquet pain and postoperative pain in patients undergoing elective hand surgery: a systematic review protocol.

Review question/objective The objective of this quantitative systematic review is to determine the effects of ondansetron as an adjunct to lidocaine on the tourniquet pain and postoperative pain of American Society of Anesthesiologists class 1 or 2 adult patients undergoing elective hand surgery with intravenous regional anesthesia. Inclusion criteria Types of participants This quantitative systematic review will consider studies that included American Society of Anesthesiologists 1 or 2 patients aged 18 years or older who used ondansetron as an adjunct to lidocaine for intravenous regional anesthesia in elective hand surgery. Types of intervention(s)/phenomena of interest This quantitative systematic review will consider studies that evaluated the analgesic effectiveness of ondansetron admixed to lidocaine for intravenous regional anesthesia in patients undergoing elective hand surgery. Patients treated with the admixture of ondansetron and lidocaine for Intravenous regional anesthesia will be compared to those who were treated with lidocaine alone. Types of outcomes This quantitative systematic review will consider studies that include the following outcome measures: 1: Tourniquet pain as measured by time to onset of tourniquet pain; 2: Postoperative pain relief as measured by first analgesic requirement time. The first analgesic requirement time is defined as the time which has elapsed after tourniquet release to the first request by the patient for analgesic and is assessed via visual analogue score in two to six hour intervals up to 24 hours postoperatively.

Lidocaine-nalbuphine versus lidocaine-tramadol for intravenous regional anesthesia

Background Regional anesthesia has been widely practiced with minimal risk of complications. The aim of this study was to compare the efficacy of nalbuphine and tramadol as separate adjuvants to lidocaine in intravenous regional anesthesia (IVRA) (Bier's block). Materials and methods This randomized double-blind controlled study was conducted in the Department of Anesthesia, Kasr Al Ainy Teaching Hospital, Cairo University, Egypt. Sixty patients, aged 20-60 years, ASA I-II, both sexes, scheduled for minor hand surgeries under IVRA were enrolled in the study. The patients were randomly allocated into three equal groups: group L ( n = 20) received lidocaine in IVRA, group LT ( n = 20) received lidocaine and tramadol mixture, and group LN ( n = 20) received lidocaine and nalbuphine mixture. The onset, duration of both sensory and motor blocks, time to first analgesic request postoperatively, and complications related to the drugs or technique were recorded. Results There was a statistically significant acceleration in the mean onsets with significant prolongation of the mean duration of sensory and motor blocks in group LT and group LN compared with group L ( P P P Conclusion The use of nalbuphine and tramadol as adjuvants to lidocaine in IVRA resulted in significant acceleration of the onset and prolongation of the duration of both sensory and motor blocks, with minimal insignificant complications. Both tramadol and nalbuphine effects were comparable.

Adding metoclopramide to lidocaine for intravenous regional anesthesia in trauma patients

Background:Metoclopromide have local anesthetic properties. The main object of performing the present study was to evaluate the analgesic effect of metoclopromide 10 mg when added to lidocaine for intravenous regional anesthesia (IVRA) of upper extremities in trauma patients.Materials and Methods:Ninety patients undergoing upper limb producer were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (Group L, n = 30) or 10 mg metoclopromide plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (group LM, n = 30) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml plus 10 mg metoclopromide intravenously (Group IM, n = 30).Results:Our study showed that the onset times for sensory and motor block were significantly shorter in Group LM compared with Group L and Group IM (4.5 ± 0.7 vs. 5.0 ± 0.7 and 5.0 ± 0.6, respectively, P = 0.006 for sensory block; 6.3 ± 0.7 vs. 5.1 ± 0.9 and 5.9 ± 0.6 respectively, P = 0.000 for motor block). The postoperative VAS scores were significantly less at 1, 5, 10, 15, and 30 minutes after tourniquet release in Group LM compared with Group L and Group IM (P < 0.05).Conclusion:The results of our study showed that adding 10 mg metoclopromide to lidocaine for IVRG in trauma patients reduced intraoperative and postoperative analgesic use till 24 hours and improve quality of anesthesia.

The effect of addition of different doses of ondansetron to lidocaine as a component of intravenous regional anesthesia: a randomized double-blinded controlled study

Background The aim of this study was to evaluate and compare the analgesic effect of adding two different doses (4or 8 mg) of ondansetron to lidocaine for intravenous regional anesthesia (IVRA). Patients and methods Ninety-nine patients were randomly assigned into three groups. IVRA was achieved with lidocaine 3 mg/kg 0.5% (C group) ( n = 33), lidocaine 3 mg/kg 0.5% plus 4 mg ondansetron (O1 group) ( n = 33) or lidocaine 3 mg/kg 0.5% plus 8 mg ondansetron (O2 group) ( n = 33). Times of onset and offset of sensory and motor blockade and the time of tourniquet pain were recorded. Postoperative visual analogue scale, time to first dose, and total amount of supplementary analgesia (diclofenac) were recorded. Results Significantly shorter onset times and longer recovery times of sensory and motor block were recorded in groups O1 and O2 compared with group C ( P P Conclusion Addition of ondansetron to lidocaine enhanced the performance of lidocaine when used in IVRA, prolonged postoperative analgesia and reduced intraoperative and postoperative analgesia. However, adding 8 mg ondansetron to lidocaine provided better analgesia than 4 mg.

Efficacy of ketamine as an adjunct to lidocaine in intravenous regional anesthesia.

This study aims to compare and evaluate the effect of adding ketamine as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, the onset and recovery times of sensory and motor block, and tourniquet pain. Forty patients undergoing surgery of the hand or forearm under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1) or lidocaine 3 mg/kg plus ketamine 50 mg (group 2) diluted to 40 mL with normal saline. Assessment parameters included the onset and recovery times of sensory and motor block, tourniquet pain, intraoperative hemodynamics, surgeon and patient satisfaction, postoperative pain, time of first analgesic request, total analgesic consumption, and adverse effects in the first 24 hours postoperatively. Groups 1 and 2 were comparable in demographic and surgical parameters. There were no differences between groups in intraoperative hemodynamics, onset and recovery times of sensory and motor block, or surgeon satisfaction index. Compared with group 1, group 2 patients showed less tourniquet pain, prolonged time to first request for postoperative rescue analgesia (5.5 ± 1.3 vs 20.4 ± 3.7 hours, P < 0.001), lower postoperative diclofenac consumption (120.00 ± 45.23 vs 55.1 ± 0.00 mg, P < 0.001), lower scores for postoperative pain as measured by the Verbal Rating Scale, higher patient satisfaction index, and a nonsignificant difference in the incidence of postoperative adverse effects between groups. The addition of ketamine to lidocaine in patients receiving IVRA significantly reduced intraoperative and postoperative analgesic requirements and improved patient satisfaction without causing significant adverse effects.

Temporary application of an additional forearm tourniquet reduces the dose of lidocaine for intravenous regional anesthesia

Background Local anesthetic toxicity is a serious complication of intravenous regional anesthesia (IVRA). We investigated whether temporary application of an additional forearm tourniquet would permit the reduction of lidocaine dosage for IVRA without affecting the quality of the block. Patients and methods One hundred patients undergoing hand surgery under IVRA were randomized to receive ketorolac 10 mg with 40 ml of either 0.5% lidocaine (conventional group, N = 50) or 0.25% lidocaine and an additional simple forearm tourniquet applied for 5 min during and after administration of the local anesthetic (forearm group, N = 50). Results Surgical anesthesia occurred more rapidly in the forearm group (6.3 ± 1.4 vs. 8.4 ± 1.8 min in the conventional group, respectively; P P = 0.387). Time to the first analgesic requirement and the total postoperative analgesic consumption were similar in the studied groups. Significantly more patients in the conventional group experienced postoperative central nervous system manifestations than those in the forearm group (15 vs. three, respectively; P = 0.004). These manifestations were shorter lived in the forearm group (5 ± 2 vs. 16 ± 6 min, in conventional group; P < 0.0001). Conclusion Temporary application of an additional forearm tourniquet speeds the onset of IVRA and permits the use of half the dose of lidocaine, hence increasing the safety profile of the block.