Sensory Block Recovery Times Research Articles

Comparison of Analgesic effect of Dexmeditomidine and Paracetamol as Adjuvant with Lignocaine Hydrochloride for Intravenous Regional Anesthesia

Objective: To compare and evaluate the analgesic effect of Dexmeditomidine and Paracetamol as adjuvant with lignocaine hydrochloride following upper limb surgeries. Study Design: Quasi-experimental study Place and Duration of Study: Combined Military Hospital, Rawalpindi, Allied Hospital, Faisalabad, Fauji Foundation Hospital, Rawalpindi Pakistan Methodology: Sixty ASA physical status I and II patients undergoing upper limb surgery were included in this study. Patients were divided into three groups (n=20) in each group. Regional anesthesia was achieved with 3mg/kg of Lignocaine hydrochloride(L) (02%) in Group A (n=20). Group B received 3 mg/kg of Lignocaine hydrochloride plus Dexmedetomidine (D/L) 0.5 μg/kg. Group C (n=20) received 3 mg/kg of lignocaine hydrochloride plus 300 mg of paracetamol (P/L). Onset and recovery time of Sensory and motor blocks and post-operative pain using visual analogue score was evaluated. Results: Group B showed significantly less sensory block onset time and motor block onset time as compared with Group Aand Group C. Similarly, sensory block recovery time and motor block recovery time were significantly more in Group B compared to other groups. visual analogue score was significantly less in Group B in comparison with Group A and C. First postoperative analgesic request time was significantly longer in the Group B than in Group C. Conclusion: It was concluded that Dexmedetomidine/Lignocaine hydrochloride provides better analgesia compared to paracetamol/Lignocaine hydrochloride in intravenous regional anesthesia.

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.

Does the Use of Nitroglycerin Patch Improve Local Anaesthetic Effects in Bier's Block? A Double-Blind Placebo Controlled Study.

Aim The aim of the study was to assess the nitroglycerin patch as a new additive to Bier's block and its impact on the effects and dose of lidocaine. Methods Forty patients of each sex belonging to ASA I or II underwent elective tendon repair surgeries of the forearm and hand. The patients were divided into two equal groups as follows: Group C received only lidocaine (1.5 mg/kg, 0.25%) and Group N received lidocaine (1.5 mg/kg, 0.25%) + 5 mg transcutaneous nitroglycerin patch. Onset and recovery times for sensory and motor block, visual analogue scale (VAS) scores for bandage pain, postoperative VAS score, analgesic requirements, patients' satisfaction, and surgeons' opinion were recorded. Results Sensory block onset time was shorter in Group N (3.80 ± 1.0) than that in Group C (5.72 ± 1.46), and motor block onset time was shorter in Group N (10.72 ± 1.93) than that in Group C (13.56 ± 1.26). Sensory block recovery time was prolonged in Group N (10.56 ± 1.12) than Group C (6.88 ± 1.45), recovery time of motor block was prolonged in Group N (13.04 ± 1.57) than Group C (11.96 ± 1.72). Bandage pain had lower VAS scores in Group N. Postoperative VAS scores showed significant differences between both groups at the following points of measurement: 30 minutes, 1 hour, and 4 hours after bandage deflation. Postoperative analgesic effect was the longest in Group N (187.20 ± 60.79 min) than Group C (51.60 ± 25.28 min). Patients' satisfaction and surgeons' opinion were better in Group N than Group C. Conclusion Supplementation of Bier's block with transcutaneous nitroglycerin patch reduces the lidocaine dose, the sensory and motor block onset times, VAS scores, and analgesic consumption intra- and postoperatively. Length of the block recovery times for the sensory and motor effects, duration of postoperative analgesic effect, and the first time to analgesic requirement improved the quality of Bier's block with better patients' satisfaction and surgeons' opinion and had no adverse effects.

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.

Evaluation of analgesic effect of nitroglycerine added to lignocaine in intravenous regional anesthesia

Background: In this study, we used nitroglycerine (NTG) as an adjuvant to lignocaine in intravenous regional anesthesia (IVRA) to enhance the analgesic property of lignocaine. Aim: To evaluate the effect of addition of NTG to lignocaine in IVRA. Objective: To find out the onset, duration, and requirement of postoperative analgesics with the addition of NTG. Materials and Methods: This was a randomized (block randomization), double-blinded, placebo-controlled study of 60 patients of the American Society of Anesthesiologists Class I and II, undergoing hand and forearm surgeries. Patients received IVRA with 3 mg/kg 2% lignocaine diluted to a total volume of 40 ml to which either 150 μg NTG or equal volume of saline was added. Intraoperatively and postoperatively, pain score was evaluated using visual analog scale. The sensory and motor block onset and recovery time and the subsequent analgesic requirement in first 24 h were recorded. Results: Motor and sensory block onset time were significantly shorter (P < 0.001), and motor and sensory block recovery time were prolonged (P < 0.001) in NTG group compared to plain lignocaine group. Intra-operatively fentanyl requirement was significantly lower and quality of sensory and motor blockade was better in study group than control group (P < 0.001). In addition, patients in NTG group required significantly less number of analgesics in the first 24 h as compared to the other group. Nitrates are potent relaxers of vascular smooth muscles and act by dilating veins, arteries, and arterioles. In IVRA, most of the anesthetic agent is absorbed into the limb tissue. Thus, the local anesthetic agent reaches to the nerves and nerve endings quickly. Thus shortens the onset time and also prolongs sensory and motor blockade and reduces total analgesic consumption in first 24 h without significant side effects. Conclusion: NTG as an adjuvant to lignocaine for IVRA reduces the total analgesic consumption in first 24 h and improves sensory and motor block without side effects.

Peri- and postanalgesic properties of lidokain, lornoxicam, and nitroglycerine combination at intravenous regional anesthesia.

Background. This study was conducted to compare and evaluate the effect of adding lornoxicam or nitroglycerine as adjuncts to lidocaine in intravenous regional anesthesia (IVRA). Methods. 60 patients were randomly separated into three groups, lidocaine group (group L), lidocaine + lornoxicam group (group LL), and lidocaine + lornoxicam + transdermal nitroglycerine group (group LL-N). Hemodynamic parameters, sensory and motor blocks onset, and recovery times were recorded. Analgesic consumption for tourniquet pain and postoperative period were recorded. Results. Sensory block onset times and motor block onset times were shorter in the LL-N and LL groups compared with L group. Sensory block recovery time and motor block recovery time were prolonged in the LL and LL-N groups compared with group L. The amount of fentanyl required for tourniquet pain was less in group LL and group LL-N when compared with group L. VAS scores of tourniquet pain were higher in group L compared with the other study groups. Postoperative VAS scores were higher for the first 4 hours in group L compared with the other study groups. Conclusion. The adjuvant drugs (lornoxicam or TNG) 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.

Comparison the effects of prilocaine and the addition of dexketoprofen and dexamethasone to prilocaine for intravenous regional anesthesia

The aim of this study was to compare the anesthetic and analgesic effects of prilocaine alone, prilocaine added dexketoprofen and dexamethasone during intravenous regional anesthesia (IVRA). Forty five patients undergoing forearm or hand surgery were randomly assigned to one of three groups to receive (Group P) 3 mg/kg 0.5% prilocaine; (Group PDK) 3 mg/kg 0.5% prilocaine plus 50 mg dexketoprofen; (Group PDM) 3 mg/kg 0.5% prilocaine plus 8 mg dexamethasone in total 40 ml volume for IVRA. The onset and duration of sensory and motor blocks, hemodynamic datas, duration of analgesia and tourniquet, time to first analgesic requirement, visual analog scale (VAS), total analgesic consumption in 24 hours and patient satisfaction score were assessed and recorded. Time to onset of sensory block was found to be longer in Group P (p<0.05), though no significance was found according to sensory block recovery times amoung groups. Time to onset of motor block was found to be longer and recovery time of motor block was found to be shorter in Group P (p<0.05). Time to first analgesic requirement was found to be longer in Group PDK,and was found to be high in Group PDM than Group PDK(p<0.05). The VAS scores was found to be high and patient satisfaction scale was found to be low in Group P (p<0.05). The addition of dexketoprofen and dexamethasone to prilocaine during IVRA improves the quality of both anesthesia and analgesia moreover dexketoprofen provides beter postoperative analgesia during the first 24 hour after surgery.

Comparação de Lornoxicam e Fentanil Adicionados à Lidocaína em Anestesia Regional Intravenosa

In this study, our goal was to compare intraoperative and postoperative analgesic effects of lornoxicam and fentanyl when added to lidocaine Intravenous Regional Anesthesia (IVRA) in a group of outpatients who underwent hand surgery.This is a double blind randomized study. A total of 45 patients were included, randomized into three groups. Patients in Group I (L) received 3 mg.kg-1 of 2% lidocaine 40 mL; patients in Group II (LL) received 3 mg.kg-1 lidocaine 38 mL + 2 mL lornoxicam; patients in Group III (LF) received 3 mg.kg-1 lidocaine 38 mL + 2 mL fentanyl. Our primary outcome was fi rst analgesic requirement time at postoperative period.Lornoxicam added to lidocaine IVRA increased the sensory block recovery time without increasing side effects and increased fi rst analgesic requirement time at the postoperative period when compared to lidocaine IVRA (p < 0.001, p < 0.001 respectively) and fentanyl added to lidocaine IVRA (p < 0.001, p < 0.001 respectively). In addition, we also found that fentanyl decreased tourniquet pain (p < 0.01) when compared to lidocaine but showed similar analgesic effect with lornoxicam (p > 0.05) although VAS scores related to tourniquet pain were lower in fentanyl group. Lornoxicam added to lidocaine IVRA was not superior to lidocaine IVRA in decreasing tourniquet pain.Addition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use.

Comparison of Lornoxicam and Fentanyl when added to Lidocaine in Intravenous Regional Anesthesia

Background and objectivesIn this study, our goal was to compare intraoperative and postoperative analgesic effects of lornoxicam and fentanyl when added to lidocaine Intravenous Regional Anesthesia (IVRA) in a group of outpatients who underwent hand surgery. MethodsThis is a double blind randomized study. A total of 45 patients were included, randomized into three groups. Patients in Group I (L) received 3mg.kg-1 of 2% lidocaine 40mL; patients in Group II (LL) received 3mg.kg-1 lidocaine 38mL + 2mL lornoxicam; patients in Group III (LF) received 3mg.kg-1 lidocaine 38mL + 2mL fentanyl. Our primary outcome was first analgesic requirement time at postoperative period. ResultsLornoxicam added to lidocaine IVRA increased the sensory block recovery time without increasing side effects and increased first analgesic requirement time at the postoperative period when compared to lidocaine IVRA (p < 0.001, p < 0.001 respectively) and fentanyl added to lidocaine IVRA (p < 0.001, p < 0.001 respectively). In addition, we also found that fentanyl decreased tourniquet pain (p < 0.01) when compared to lidocaine but showed similar analgesic effect with lornoxicam (p > 0.05) although VAS scores related to tourniquet pain were lower in fentanyl group. Lornoxicam added to lidocaine IVRA was not superior to lidocaine IVRA in decreasing tourniquet pain. ConclusionsAddition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use.

Addition of Dexmedetomidine or Lornoxicam to Prilocaine in Intravenous Regional Anaesthesia for Hand or Forearm Surgery

Intravenous regional anaesthesia (IVRA) is a simple and cost-effective technique that is ideally suited for surgery involving the distal arm. This study compared the effect of lornoxicam or dexmedetomidine in IVRA with prilocaine in patients who underwent hand or forearm surgery. M ethods: This randomized, double-blind study enrolled 75 patients scheduled for hand or forearm surgery. IVRA was achieved with 2% prilocaine 3 mg/kg in the control group (n=25), 2% prilocaine 3 mg/kg plus dexmedetomidine 0.5 microg/kg in the dexmedetomidine group (n=25), and 2% prilocaine 3 mg/kg plus lornoxicam 8 mg in the lornoxicam group (n=25). In all groups, 0.9% NaCl solution was added to make up a total volume of 40 mL. Sensory and motor block onset and recovery times, haemodynamic variables, visual analogue scale (VAS) pain and sedation scores, duration of analgesia, total analgesic consumption over 24 hours, adverse effects and quality of anaesthesia were recorded. Sensory block onset was shorter and sensory block recovery time longer in the dexmedetomidine group compared with the lornoxicam and control groups (p<0.05). Sensory and motor block recovery times and duration of analgesia for tourniquet were prolonged in the dexmedetomidine and lornoxicam groups compared with the control group (p<0.05). Median VAS scores for tourniquet pain in the dexmedetomidine and lornoxicam groups were lower than that of the control group at 15 and 30 minutes (p<0.05). Postoperatively, the duration of analgesia time was longer and median VAS scores were lower during the first 12 hours in the dexmedetomidine and lornoxicam groups compared with the control group (p<0.05). Total analgesic consumption over 24 hours was lower in the dexmedetomidine and lornoxicam groups compared with the control group (p<0.05). Anaesthesia quality as determined by the anaesthesiologist was better in the dexmedetomidine and lornoxicam group than in the control group (p<0.05). Addition of dexmedetomidine or lornoxicam to prilocaine in IVRA decreased VAS pain scores, improved anaesthesia quality and decreased analgesic requirement. We suggest that addition of dexmedetomidine or lornoxicam at the doses used in this study to IVRA with prilocaine in this setting can be useful without causing adverse effects. No hypotension, bradycardia or hypoxia requiring treatment was seen in any of the patients. Addition of dexmedetomidine had a more potent effect, shortening sensory block onset time and prolonging sensory block recovery time more than lornoxicam.