Comparison of Ropivacaine and Lidocaine for Intravenous Regional Anesthesia in Volunteers

1999 ◽  
Vol 90 (6) ◽  
pp. 1602-1608. ◽  
Author(s):  
Vincent W. S. Chan ◽  
Mitchell J. Weisbrod ◽  
Zsuzsanna Kaszas ◽  
Camelia Dragomir
Keyword(s):  
Regional Anesthesia ◽  
Electric Stimulation ◽  
Motor Block ◽  
Muscle Power ◽  
Venous Blood ◽  
High Dose ◽  
Partial Recovery ◽  
Lidocaine Group ◽  
Intravenous Regional Anesthesia ◽  
Tourniquet Release

Background Ropivacaine may be useful for intravenous regional anesthesia, but its anesthetic effectiveness and toxicity have not been evaluated. Methods Two doses of ropivacaine (1.2 and 1.8 mg/kg) and one dose of lidocaine (3 mg/kg) were compared for intravenous regional anesthesia in 15 volunteers. An arm tourniquet was inflated for 30 min after injection and then deflated in two cycles. Sensory block was measured by response to touch, cold, pinprick, and transcutaneous electric stimulation, and motor function was measured by hand grip strength and muscle power. Median, ulnar, radial, and musculocutaneous nerve functions were tested before local anesthetic injection and then at 5-min intervals until blocks resolved. The plasma ropivacaine and lidocaine concentrations were determined from arterial and venous blood samples drawn from the unanesthetized arm. Results Sensory and motor blocks were complete within 25 min and 30 min, respectively, in all three treatment groups. However, recovery of sensory and motor block after tourniquet release was slowest in the high-dose ropivacaine group. Anesthesia to pinprick and transcutaneous electric stimulation was sustained in all the volunteers in the high-dose ropivacaine group for 55 min and 85 min, respectively, whereas complete recovery was observed in the lidocaine group (P = 0.008) and partial recovery in the low-dose ropivacaine group (P < 0.05) during the same period. Motor block also was sustained in the high-dose ropivacaine group for 70 min, which was significantly longer than in the lidocaine group (P < 0.05). All volunteers (five of five) given lidocaine and one volunteer given high-dose ropivacaine reported light-headedness and hearing disturbance during tourniquet release when the arterial plasma lidocaine and ropivacaine concentrations were 4.7+/-2.1 microg/ml (mean) and 2.7 micro/ml, respectively. Conclusion Compared with lidocaine, intravenous regional anesthesia with ropivacaine appears to be comparable but has longer-lasting residual anesthesia.

scholarly journals Peri- and Postanalgesic Properties of Lidokain, Lornoxicam, and Nitroglycerine Combination at Intravenous Regional Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Biricik Melis Cakmak ◽  
Gokhan Cakmak ◽  
Elif Akpek ◽  
Gulnaz Arslan ◽  
Mehmet Sukru Sahin
Keyword(s):  
Regional Anesthesia ◽  
Recovery Time ◽  
Motor Block ◽  
Sensory Block ◽  
Study Groups ◽  
The Other ◽  
Lidocaine Group ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Vas Scores

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.

Bilateral Intravenous Regional Anesthesia

2003 ◽  
Vol 98 (6) ◽  
pp. 1427-1430 ◽  
Author(s):  
Maximilian W.B. Hartmannsgruber ◽  
Sabine Plessmann ◽  
Peter G. Atanassoff
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effects ◽  
Regional Anesthesia ◽  
Normal Saline ◽  
Drug Combinations ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Study Session ◽  
Tourniquet Release

Background Ketorolac, when added to lidocaine, has been shown to reduce early tourniquet pain during intravenous regional anesthesia (i.v.RA) in patients. Although the effectiveness of ropivacaine 0.2% for i.v.RA is equal to that of lidocaine 0.5% but significantly reduces central nervous system side effects after release of the tourniquet, it provides no advantage with regard to tourniquet tolerance times. Simultaneous bilateral i.v.RA with ropivacaine 0.2% was used to test the hypothesis that ketorolac modifies tourniquet tolerance and to test whether drug combinations can be evaluated in one study session. Methods Ten healthy, unsedated volunteers received 30 ml of ropivacaine 0.2% in each upper arm with 2 ml of normal saline in one arm and 30 mg of ketorolac in the contralateral arm for i.v.RA. Both proximal tourniquets remained inflated for 30 min, followed by inflation of the distal tourniquets and release of the proximal ones. Verbal numeric scores for tourniquet pain were recorded for both extremities. Central nervous system side effects were graded after release of each distal tourniquet. Results There was no difference between the two upper extremities with regard to surgical anesthesia and tourniquet tolerance. Total tourniquet tolerance was a median of 58.5 min (range, 45-90 min) and 60.5 min (39-79 min) in the normal saline and ketorolac groups, respectively. After release of the distal tourniquets, 5 of 10 volunteers experienced mild dizziness. Conclusions The addition of ketorolac to ropivacaine does not improve tourniquet tolerance. Minimal central nervous system side effects after tourniquet release suggest that a total of 60 ml ropivacaine 0.2% for bilateral i.v.RA is a useful model for comparison of i.v.RA drug combinations.

Ropivacaine 0.2% and Lidocaine 0.5% for Intravenous Regional Anesthesia in Outpatient Surgery

2001 ◽  
Vol 95 (3) ◽  
pp. 627-631 ◽  
Author(s):  
Peter G. Atanassoff ◽  
Carlos A. Ocampo ◽  
Marcos Castro Bande ◽  
Maximilian W. B. Hartmannsgruber ◽  
Thomas M. Halaszynski
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Outpatient Surgery ◽  
Postanesthesia Care Unit ◽  
Double Blind Study ◽  
Double Blind ◽  
Lidocaine Group ◽  
Binding Effect ◽  
Pain Scores ◽  
Intravenous Regional Anesthesia

Background A longer-acting local anesthetic agent, such as ropivacaine, may offer advantages over lidocaine for intravenous regional anesthesia. The objectives of this study were to evaluate whether the findings of volunteer investigations with intravenous regional anesthesia with ropivacaine (which have shown prolonged analgesia after release of the tourniquet) translates into improved pain control after surgery. Methods With Human Investigation Committee approval and a double-blind study design, 20 healthy patients with American Society of Anesthesiologists physical status I or II classification who were scheduled to undergo forearm and hand surgery were randomly assigned to administration of 40 ml of either 0.2% ropivacaine or 0.5% lidocaine for intravenous regional anesthesia. Evidence of central nervous system side effects, such as lightheadedness, tinnitus, and metallic taste, as well as cardiac arrhythmias, were evaluated and treated (if necessary) after local anesthetic administration, before and during surgery, and after release of the tourniquet until discharge from the postanesthesia care unit. Regression of sensory anesthesia in the nerve distributions of the forearm and hand was recorded. Verbal numerical pain scores were monitored and quantified until the patients were discharged to home from the postanesthesia care unit. Patient pain scores, side effect profiles, time to first oral intake, and total amount of oral analgesics were recorded 24 h postoperatively. Results Intravenous regional anesthesia with 0.2% ropivacaine and 0.5% lidocaine provided equivalent levels of surgical anesthesia. After release of the tourniquet, the first evidence for return of sensation in the distribution of the five peripheral nerves occurred later in the ropivacaine group (median, 20 min; range, 15-40 min) than in the lidocaine group (median, 1 min; range, 1-25 min). Verbal numerical pain scores were significantly lower at the time of admission, whereas during the remainder of the postanesthesia care unit stay and later at home, the difference in verbal numerical pain scores between the two groups was no longer statistically significant. Conclusions Ropivacaine 0.2% may be an alternative to 0.5% lidocaine for intravenous regional anesthesia in the outpatient surgical setting. Longer-lasting analgesia in the immediate postoperative period may be due to a more profound and prolonged tissue binding effect of ropivacaine.

A COMPARATIVE STUDY OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADJUNCT TO LIDOCAINE IN INTRAVENOUS REGIONAL ANESTHESIA

2021 ◽  
Vol 74 (9) ◽  
pp. 2259-2264
Author(s):  
Diana Salam Sami ◽  
Ali Hadi Muslih
Keyword(s):  
Regional Anesthesia ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Intravenous Regional Anesthesia ◽  
Group 3 ◽  
Group 2 ◽  
Different Doses ◽  
Group 1

The aim: To compare the different doses of dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia. Materials and methods: Ninety patients participated in this study in Al-Yarmook teaching hospital in period between January 1st 2016 – July 1st 2016, divided randomly in to 3 groups. Group 1: received lidocaine diluted with normal saline; Group 2 – lidocaine with dexmedetomidine 0.5 μg/kg; Group3 -lidocaine with dexmedetomidine 1 μg/kg. Statistical analysis was done by IBM SPSS program version 20 and Microsoft excel version 2010 , the means were compared by ANOVA methods and Dunnett t3, significancebetween groups were recorded if p value less than 0.05. Results: Dexmedetomidine was effective in decreasing the sensory block onset time and motor block onset time and prolongation of the motor and sensory recovery with no significant hemodynamic changes than is often shown by the lidocaine alone, it also prolongs the time interval for analgesic requirement after the operation. For the group 3 it was faster than in group 2 and faster than in group 1 significantly (p value < 0.001) to form a sensory block onset and motor block onset; and it took significantly more time to recover the sensation than in group 1 (p value <0.001) and 2 (p value <0.002) , and more time for motor recovery than in group 1 (p value < 0.001). Group 3 had the longest time to call for the analgesia after operation than group 2 and 3 (p value < 0.001); and group 2 also had longer time for the same process than group 1 (p value < 0.001). Conclusions: A variety of adjuvants have been used in IVRA to decrease tourniquet pain, improve block quality, and prolong analgesia after cuff deflation. Opioids are relatively ineffective and cause nausea, vomiting, and dizziness after tourniquet deflation, but several NSAIDs have been shown to be beneficial, dexmedetomidine improves block quality and postoperative analgesia.

scholarly journals The effects of different anesthesia techniques on free radical production after tourniquet-induced ischemia-reperfusion injury at children's age

2010 ◽  
Vol 67 (8) ◽  
pp. 659-664 ◽  
Author(s):  
Ivana Budic ◽  
Dusica Pavlovic ◽  
Tatjana Cvetkovic ◽  
Nina Djordjevic ◽  
Dusica Simic ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Regional Anesthesia ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Venous Blood ◽  
Orthopedic Procedures ◽  
Time Points ◽  
Significant Difference ◽  
Tourniquet Release ◽  
American Society

Background/Aim. Reperfusion of previously ischemic tissue leads to injuries mediated by reactive oxygen species. The aim of the study was to investigate the effects of different anesthesia techniques on oxidative stress caused by tourniquetinduced ischemia-reperfusion (IR) injury during extremity operations at children's age. Methods. The study included 45 patients American Society of Anesthesiologists (ASA) classification I or II, 8 to 17 years of age, undergoing orthopedic procedures that required bloodless limb surgery. The children were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release (BTR), 5 and 20 min after tourniquet release (ATR). Postischemic reperfusion injury was estimated by measurement of concentration of malondialdehyde (MDA) in plasma and erythrocytes as well as catalase (CAT) activity. Results. Plasma MDA concentration in the group S was significantly higher at 20 min ATR in comparison with the groups T and R (6.78 ? 0.33 ?molL-1-1 vs 4.07 ? 1.53 and 3.22 ? 0.9. ?molL-1-1, respectively). There was a significant difference in MDA concentration in erytrocythes between the groups S and T after 5 min of reperfusion (5.88 ? 0.88 vs 4.27 ? 1.04 nmol/mlEr, p < 0.05). Although not statistically significant, CAT activity was slightly increased as compared to baseline in both groups S and R. In the group T, CAT activity decreased at all time points when compared with baseline, but the observed decrease was only statistically significant at BTR (34.70 ? 9.27 vs 39.69 ? 12.91 UL-1, p < 0.05). Conclusion. Continuous propofol infusion and regional anesthesia techniques attenuate lipid peroxidation and IR injury connected with tourniquet application in pediatric extremity surgery.

scholarly journals Biomarkers of Oxidative Stress and Endothelial Dysfunction After Tourniquet Release in Children

2011 ◽  
pp. S137-S145
Author(s):  
I. BUDIC ◽  
D. PAVLOVIC ◽  
G. KOCIC ◽  
T. CVETKOVIC ◽  
D. SIMIC ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Endothelial Dysfunction ◽  
Regional Anesthesia ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Venous Blood ◽  
Total Intravenous Anesthesia ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Tourniquet Release

Pneumatic tourniquets are widely used in pediatric extremity surgery to provide a bloodless field and facilitate dissection. This prospective study was carried out to examine possible effect of different anesthesia techniques on oxidative stress and endothelial dysfunction connected with ischemia-reperfusion injury during extremity operations at children's age. Patients were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples for determination of the malondialdehyde in plasma and erythrocytes, protein carbonyl groups concentration as well as plasma nitrites and nitrates level and xanthine oxidase activity were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release, 5 and 20 min after tourniquet release. This study demonstrates that total intravenous anesthesia with propofol and regional anesthesia techniques provide better antioxidant defense and reduce endothelial dysfunction than general inhalational anesthesia with sevoflurane during tourniquet application in pediatric extremity surgery.

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

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Abdulkadir Yektaş ◽  
Funda Gümüş ◽  
Abdulhalim Karayel ◽  
Ayşin Alagöl
Keyword(s):  
Regional Anesthesia ◽  
Recovery Time ◽  
Motor Block ◽  
Onset Time ◽  
Hand Surgery ◽  
Cost Effective ◽  
Analgesic Requirement ◽  
Intravenous Regional Anesthesia ◽  
Clinical Benefits ◽  
American Society

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.

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