Acute Aphesia Following Tourniquet Release in Intravenous Regional Anesthesia With 0.75% Lidocaine

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.

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A Comparative Study of the Anesthetic Efficacy, Post Tourniquet Release Analgesia and Side Effects of Ropivacaine 0.2% & Lignocaine 0.5% in Intravenous Regional Anesthesia for Hand Surgeries

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i2.174 ◽

2019 ◽

Vol 7 (2) ◽

Author(s):

A Gowri Shankar ◽

Keyword(s):

Side Effects ◽

Comparative Study ◽

Regional Anesthesia ◽

Intravenous Regional Anesthesia ◽

Tourniquet Release

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Comparison of Ropivacaine and Lidocaine for Intravenous Regional Anesthesia in Volunteers

Anesthesiology ◽

10.1097/00000542-199906000-00016 ◽

1999 ◽

Vol 90 (6) ◽

pp. 1602-1608. ◽

Cited By ~ 35

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.

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