Quality Of Intravenous Regional Anesthesia Research Articles

Effect of neostigmine versus dexamethasone on quality of intravenous regional anesthesia: a randomized double-blinded controlled study

Background Pain is a great problem after surgical trauma. Acute postoperative pain incidence was reported to be more than 60% and was not adequately controlled. The authors aimed to investigate the effect of neostigmine versus dexamethasone on the duration of anesthesia and postoperative analgesia when added to lidocaine in a Bier block. Materials and methods This randomized double-blind controlled study was carried out on 75 patients scheduled for elective surgeries under intravenous regional anesthesia (Bier block). They were randomly allocated into three groups: group C (n=25, received intravenous 3 mg/kg lidocaine 2%), group D (n=25, received intravenous 3 mg/kg lidocaine 2%+8 mg dexamethasone), and group N (n=25, received intravenous 3 mg/kg lidocaine 2%+0.5 mg neostigmine). Visual analog scale (VAS) was used postoperatively to assess pain. Sensory and motor block characteristics and duration of postoperative analgesia were evaluated. Results The pain scores with the postoperative VAS data were statistically significant lower in the group D patients than those of groups C and N at 90 min, 105 min, and 120 min (P Conclusion The addition of dexamethasone 8 mg to lidocaine 2% (3 mg/kg) during intravenous regional anesthesia provided better postoperative analgesia. When compared with the control group or the neostigmine group, dexamethasone increased the duration of postoperative analgesia.

Effect of adding dexamethasone to lidocaine on the quality of intravenous regional anesthesia for upper extremity orthopedic operations: A randomized clinical trial.

BackgroundIntravenous regional anesthesia (IVRA) is an ideal technique for short surgery on the distal extremities. Different additives have been used to improve lidocaine’s block quality.ObjectiveThe aim of this study was to determine the effect of adding dexamethasone to lidocaine on improving the quality of IVRA.MethodsThis study is a prospective, double-blind randomized study which was done on patients with upper extremity injuries of the distal elbow in Shahid Mohammadi Hospital, Bandar Abbas from October 2014 to December 2015. A total of 110 patients aged 15 to 65 years, with ASA class I and II, with orthopedic injuries distal to the elbow, were randomly divided into two groups. The control group (L) and the intervention group (L+D) received a 40-ml solution of 3 mg/kg lidocaine, and 3 mg/kg lidocaine + 8 mg of dexamethasone respectively. The two groups were compared in terms of onset and recovery time of sensory block in each of the dermatome nerves classified as radial, ulnar, and median, vital signs, patient satisfaction, intraoperative opioid consumption, and request for the first postoperative opioid.ResultsThere was no significant difference between the two groups in terms of demographic characteristics. Mean arterial blood pressure was higher in the L + D group (100.39±14.6 mmHg) in comparison to the L group (90.50±11 mmHg) (p=0.002). Need for opioid was reported in 20 (35.7%) patients in the L + D group in comparison to 17 (31.5%) in the L group (p=0.639). The average intraoperative dose of fentanyl was 95±32.04 mcg and 88.44±18.77 mg in L + D and L groups respectively and there was no significant difference between the two groups in this respect (p=0.479). In addition, the average dose of pethidine administered in the recovery room for L + D group (19.34±15.22) mg was significantly higher than in the L group (9.44±12.26 mg) (p=0.001).ConclusionsAdding 8 mg dexamethasone to lidocaine has no effect on IVRA solution in upper extremity orthopedic operations and also increases postoperative opioid consumption.Trial registrationThe trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016052928158N1.FundingThe authors received financial support from Hormozgan University of Medical Sciences.

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.

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.

Efficacy of intravenous regional anesthesia with dexmedetomidine: local addition versus systemic infusion

Background Intravenous regional anesthesia (IVRA) is a type of regional anesthesia that is administered using a pneumatic tourniquet isolating the limb from the systemic circulation. IVRA has been limited by tourniquet pain and the inability to provide postoperative analgesia. Thus, to improve the quality of IVRA and avoid these problems, additives are added to local anesthetics. We designed this study to evaluate the efficacy of IVRA by using dexmedetomidine locally versus an intravenous systemic infusion. Materials and methods Overall, 60 ASA I-II patients of either sex, 18-65 years old, scheduled for hand or distal forearm surgeries were studied. Patients were divided randomly into three groups (20 patients each): group L received 3 mg/kg lignocaine completed to 40 ml normal saline (NS), group LD1 received 0.5 μg/kg dexmedetomidine added to 3 mg/kg lignocaine completed to 40 ml NS, and group LD2 received 3 mg/kg lignocaine completed to 40 ml NS plus an intravenous infusion of 1 μg/kg dexmedetomidine over 10 min 15 min before IVRA, followed by maintenance of dexmedetomidine infusion at the rate of 0.02-0.06 μg/kg/min. Onset and recovery times of sensory and motor blocks, tourniquet pain, rescue analgesia, and visual analogue scale postoperatively were monitored. Results Onset and recovery times of sensory and motor blocks were shorter in group LD1 compared with the other two groups. Time of tourniquet pain was found to be prolonged in groups LD1 and LD2 compared with group L. The use of rescue fentanyl and tramadol in the first 24 h was increased in group L versus both the other two groups. Conclusion Local addition of dexmedetomidine to IVRA produced shorter onset and slower recovery of sensory and motor blocks compared with systemic infusion of dexmedetomidine. The durations of postoperative analgesia and rescue analgesia were comparable between both groups using dexmedetomidine either locally or systemically.

Potential advantages of an additional forearm rubber tourniquet in intravenous regional anesthesia: a randomized clinical trial.

Although the usefulness of an additional forearm tourniquet to conventional intravenous regional anesthesia (IVRA) has been reported, the forearm cuff may disturb the surgical field to some degree, especially in wrist surgery. In the present study, we assessed the clinical efficacy of a temporary additional forearm rubber tourniquet to the conventional upper arm tourniquet on the quality of IVRA. The study included 32 ASA physical status I and II adult patients undergoing elective hand surgery who were randomly allocated to either an additional forearm tourniquet group (Group F) or to a conventional upper arm tourniquet group (Group C). Upper arm tourniquet IVRA was established using 40mL of 0.5% lidocaine in Group C. Hypothetically enhanced forearm tourniquet IVRA was established using 10mL of 0.5% lidocaine with an additional forearm rubber tourniquet and then administering 30mL of 0.25% lidocaine after removing the forearm tourniquet in Group F. The sensory and motor block onset and recovery times, onset time of tourniquet pain, intraoperative fentanyl consumption, and incidence of local anesthetic toxicity were recorded. The numerical rating score (NRS) of perioperative and postoperative pain and quality of anesthesia were also assessed. Although the total dose of lidocaine in Group F was less and the sensory and motor block onset times were significantly shorter in Group F than those in Group C (P<0.05), there was no difference regarding sensory and motor block recovery times, onset time of tourniquet pain, intraoperative fentanyl consumption, NRS of perioperative and postoperative pain, and the quality of anesthesia in the two groups (P>0.05). Compared with Group C, the incidence of local anesthetic toxicity (i.e., dizziness, 43.8 vs 6.2%, P=0.02) was significantly decreased in Group F. The combination of the additional forearm and upper arm tourniquets with a smaller amount of local anesthetic achieved more rapid onset of sensory and motor block, a similar quality of anesthesia and a lower incidence of local anesthetic toxicity compared with the conventional technique.

Evaluating the quality of intravenous regional anesthesia following adding dexamethasone to lidocaine

Objectives:The quality of anesthesia in intravenous regional anesthesia (IVRA) has been evaluated in many studies so far. This study was designed to evaluate the effects of adding the dexamethasone to lidocaine on the quality of IVRA.Materials and Methods:A double-blind clinical trial was set up involving 50 hand surgery candidates, 20 to 55 years old, and with American Society of Anesthesiologists class of I and II. Patients were randomly allocated into two groups of 25 cases and received either 3 mg/kg of lidocaine (control group) or 3 mg/kg of lidocaine plus 8 mg of dexamethasone (study group). The onset and recovery times from sensory and motor blocks, the starting time of tourniquet pain, the amount of narcotics needed during patients’ recovery, and probable side-effects were all compared between the two groups.Results:No significant differences were detected concerning age, gender, length of surgery and the mean time of starting of tourniquet pain between the two groups. The mean times of both sensory (P = 0.002) and motor (P = 0.004) blocks onset were significantly shorter in the study group. The mean time of recovery from sensory block was significantly longer in the study group (P = 0.01). The average amount of narcotics needed during the recovery was significantly lower in the study group (P = 0.01). No side-effect was detected.Conclusion:We conclude that adding the dexamethasone to lidocaine can improve the quality of anesthesia in IVRA.

Comparison between dexmedetomidine and magnesium sulfate as adjuvants for intravenous regional anesthesia

Background Many adjuvants have been used to improve the quality of intravenous regional anesthesia (IVRA). The aim of this study was to compare the use of dexmedetomidine with that of magnesium sulfate as an adjuvant for IVRA as regards onset and duration of sensory and motor blocks, quality of anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative and postoperative pain. Patients and Methods This study was a prospective, randomized, double-blinded trial. Sixty patients scheduled for upper hand or forearm surgery were randomly divided into two groups, comprising 30 patients each. Group D received dexmedetomidine at 0.5 μg/kg diluted with saline to 20 ml in addition to 20 ml of 1% lidocaine to reach a total volume of 40 ml, whereas group M received 5 ml of 20% magnesium sulfate and 15 ml saline added to 20 ml of 1% lidocaine to reach a total volume of 40 ml. Sensory and motor block onset, recovery times, anesthesia quality, and hemodynamic variables were recorded and compared between the two groups. Results No statistically significant difference was observed between dexmedetomidine and magnesium sulfate as regards sensory block onset time and motor block onset time ( P = 0.102 and 0.206, respectively) as well as intraoperative analgesic requirements ( P = 0.76). However, dexmedetomidine showed more favorable hemodynamic variables and less tourniquet pain. Conclusion We concluded that dexmedetomidine seems to be superior to magnesium sulfate as an adjuvant to lidocaine in IVRA regarding tourniquet pain and intraoperative and postoperative hemodynamic stability.

Intravenous regional anesthesia: effect of magnesium using two different routes of administration

Background Magnesium has been reported as an adjuvant to local anesthetics to improve the quality of intravenous regional anesthesia (IVRA); however, different routes of administration have not been compared before. The aim of this study was to compare between the effect of intravenous infusion of magnesium and the effect when it is added to a local anesthetic on the quality of analgesia and opioid consumption during IVRA in patients undergoing hand surgery. Patients and methods Fifty-nine patients undergoing elective hand surgery were randomly allocated to one of three groups: the R group ( n = 20 patients), which received IVRA using ropivacaine 0.2%; the RM group ( n = 20 patients), which received IVRA using ropivacaine 0.2% and magnesium sulfate 10 mg/kg; and the RMV group ( n = 19 patients), which received IVR using ropivacaine 0.2% and a systemic intravenous single dose of magnesium sulfate 30 mg/kg. The primary outcome measure included morphine consumption in the first 24 h andthe secondary outcome measure included onset of both sensory and motor blockade, tourniquet pain, intraoperative fentanyl consumption, and postoperative pain using the Verbal Rating Scale (VRS). Results Onset times of sensory and motor blockades were shorter in the RM group (10.5 ± 4 and 14 ± 5 min) than in the R group (16.5 ± 6 and 21 ± 6 min) and RMV group (16 ± 5.5 and 20.5 ± 5.3 min). Time to first analgesic requirement was significantly longer in the RMV group (98 ± 12 min) than in the R group (70 ± 11 min) and RM group (75 ± 13 min), whereas the 24 h morphine consumption in the RMV group (14.5 ± 8.7 mg) was significantly lower than that in the RM group (25 ± 10 mg)and Rgroup (27 ± 15 mg). Tourniquet discomfort was significantly lower in the RM group [1 (0-2)] than in the R group [2 (1-4)] and RMV group [3 (1-4)]. Intraoperative fentanyl consumption was lower in the RM group (20.5 ± 9) than in the Rgroup (43.8 ± 9) and RMV group (38 ± 15),whereas VRS was significantly lower in the RM Vgroup at 1, 3, 6, and 12 h ( P < 0.05) in comparison with the other groups. Conclusion The addition of magnesium to ropivacine in the IVRA improved the quality of block and reduced the tourniquet discomfort,and the systemic magnesium administration reduced the postoperative pain and morphine consumption.

The analgesic effect of nitroglycerin added to lidocaine on quality of intravenous regional anesthesia in patients undergoing elective forearm and hand surgery

To evaluate the effect of nitroglycerine (NTG) on sensory and motor block onset and recovery time as well as the quality of tourniquet pain relief, when added to lidocaine (LID) for intravenous regional anesthesia in elective forearm and hand surgery. A randomized double-blinded clinical trial was performed on 40 patients that were randomly allocated into two groups received lidocaine 3 mg/kg with NTG 200 µg or received only lidocaine 3 mg/kg as the control. There was no difference between the two study groups in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation. There was no difference in the mean of pain score over time between the two groups. The onset time of sensory and motor blockades was shorter in the group received both LID and NTG. The mean recovery time of sensory blockade was longer in the former group. The frequency of opioid injections was significantly lower in those who administered LID and NTG. The adjuvant drug of NTG when added to LID is effective in improving the overall quality of anesthesia, shortening onset time of both sensory and motor blockades, and stabling homodynamic parameters in hand and forearm surgery.

Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

Aims:To compare and evaluate the effect of adding ketamine or nitroglycerin (NTG) as adjuncts to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, sensorial and motor block onset times, and tourniquet pain.Settings and Design:A prospective, randomized, double-blind study was carried out.Materials and Methods:Seventy-five patients undergoing hand surgery were divided into three groups as follows: control group receiving lidocaine 2%, LK group receiving lidocaine 2% with ketamine, and LN group administered lidocaine 2% with NTG. Sensory and motor blocks' onset and recovery times were recorded. Visual analog scale (VAS) for tourniquet pain was measured after tourniquet application and it was also used to measure postoperative pain. Analgesic consumption for tourniquet pain and postoperatively were recorded.Results:Sensory block onset times were shorter in the LK (4.4 ± 1.2 minutes) and LN (3.5 ± 0.9 minutes) groups compared with the control group (6.5 ± 1.1 minute) (P < 0.0001) and motor block onset times were shorter in the LK (7.3 ± 1.6 minutes) and LN (3.6 ± 1.2 minutes) groups compared with the control group (10.2 ± 1.5 minutes) (P< 0.0001). Sensory recovery time prolonged in the LK (6.7 ± 1.3 minutes) and LN (6.9 ± 1.1 minutes) groups compared with the control group (5.3 ± 1.4 minutes) (P = 0.0006 and < 0.0001, respectively). Motor recovery time prolonged in the LK (8.4 ± 1.4 minutes) and LN (7.9 ± 1.1 minutes) groups compared with the control group (7.1 ± 1.3 minutes) (P = 0.0014 and 0.023, respectively). The sensory and motor block onset times were also shorter in LN group than in the LK group (3.5 ± 0.9 versus 4.4 ± 1.2 minutes, P=0.004; and 3.6 ± 1.2 versus 7.3 ± 1.6 minutes, P < 0.0001, respectively). The amount of fentanyl required for tourniquet pain was less in adjuvant groups when compared with control group. It was 13.6 ± 27.9 and 27.6 ± 34.9 µg in LK group and LN groups, respectively, versus 54.8 ± 28 µg in the control group. VAS scores of tourniquet pain were higher at 10, 20, 30, 40 minutes in the control group compared with the other study groups (P < 0.0001). It was also higher in LN group compared with LK group at 30 and 40 minutes (P < 0.001). Postoperative VAS scores were higher for the first 4 h in control group compared with the other study groups (P< 0.0001).Conclusions:The adjuvant drugs (ketamine or NTG) when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance and improving the postoperative analgesia in comparison to the control group. Ketamine as an adjuvant produced better tolerance to tourniquet than the other groups. NTG as an adjuvant produced faster onset of sensory and motor blockades in comparison to other groups.

Does Dexamethasone Improve the Quality of Intravenous Regional Anesthesia and Analgesia? A Randomized Controlled Clinical Study

Does Dexamethasone Improve the Quality of Intravenous Regional Anesthesia and Analgesia? A Randomized Controlled Clinical Study

Premedication with Gabapentin: The Effect on Tourniquet Pain and Quality of Intravenous Regional Anesthesia

Gabapentin, an oral non-opioid analgesic, has been used to decrease pain after a variety of surgical procedures. We hypothesized that premedication with gabapentin would minimize tourniquet-related pain in patients receiving IV regional anesthesia (IVRA). Patients undergoing elective hand surgery with IVRA were randomly assigned to one of two study groups using a double-blind study design. The control group (n = 20) received placebo capsules 1 h before the surgery, and the gabapentin group (n = 20) received gabapentin 1.2 g p.o. before the operation. IVRA was achieved in all patients with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Fentanyl, 0.5 microg/kg IV, was administered as a rescue analgesic during surgery. Sensory and motor block onset and recovery times, tourniquet pain, and quality of anesthesia were assessed at specific time intervals during the perioperative period. Visual analog scale pain scores (0-10) were recorded during the 24 h follow-up period, and patients received diclofenac, 75 mg IM, if their pain score was >4. The onset of the sensory and motor block did not differ between the two study groups. However, tourniquet pain scores at 30, 40, 50, and 60 min after cuff inflation were lower in the gabapentin group (P < 0.05). The time to intraoperative analgesic rescue was prolonged in the gabapentin group (35 +/- 10 min vs 21 +/- 13 min, P < 0.05), and less supplemental fentanyl was required (35 +/- 47 microg vs 83 +/- 73 microg, P < 0.05). The quality of anesthesia, as independently assessed by the anesthesiologist and the surgeon, was significantly better in the gabapentin (versus control) group. In the gabapentin group, the time to requesting a rescue analgesic after surgery was prolonged (135 +/- 25 min vs 85 +/- 19 min, P < 0.05), and postoperative pain scores at 60 min (3.8 +/- 0.9 vs 2.2 +/- 0.5) and 120 min (3.2 +/- 1.4 vs 1.8 +/- 0.8), as well as diclofenac consumption (30 +/- 38 mg vs 60 +/- 63 mg), were reduced after surgery. Premedication with oral gabapentin (1.2 g) decreased tourniquet-related pain and improved the quality of anesthesia during hand surgery under IVRA. Gabapentin also reduced pain scores in the early postoperative period.

Does Dexamethasone Improve the Quality of Intravenous Regional Anesthesia and Analgesia? A Randomized, Controlled Clinical Study

We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexamethasone, and group LDc received 3 mg/kg lidocaine for IVRA and 8 mg dexamethasone IV to the nonsurgical arm. IVRA was established using 40 mL of a solution. Visual analog scale and verbal pain scores were recorded intraoperatively and for 2 h postoperatively. Postoperative pain was treated with oral acetaminophen 500 mg every 4 h when visual analog scale score was more than 3. Time to request for the first analgesic and the total dose in the first 24 h were noted. Times to onset of complete sensory and motor block were similar in the 3 groups. The times to recovery of motor block (L = 8 [5.91-10.08] min, LD = 13 [6.76-20.19] min, LDc = 6 [4.44-8.43] min) and sensory block (L = 7 [5.21-10.30] min, LD = 12 [6.11-19.40] min and LDc = 6 [4.2-8.11] min) were longer in group LD (P < 0.05). Patients in group LD reported significantly lower pain scores and required less acetaminophen in the first 24 h after surgery. In conclusion, the addition of 8 mg dexamethasone to lidocaine for IVRA in patients undergoing hand surgery improves postoperative analgesia during the first postoperative day.