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.

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 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.

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 &lt; 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 &lt; 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 Does the Use of Nitroglycerin Patch Improve Local Anaesthetic Effects in Bier’s Block? A Double-Blind Placebo Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Ahmed Said Elgebaly
Keyword(s):  
Analgesic Effect ◽  
Recovery Time ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Controlled Study ◽  
Patients Satisfaction ◽  
Recovery Times ◽  
Vas Scores ◽  
Motor Effects

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.

Novel compound LL-a produces long and nociceptive-selective regional anesthesia via TRPV1 channels in rodents sciatic nerve block model

2020 ◽  
Vol 45 (6) ◽  
pp. 412-418
Author(s):  
Cheng Zhou ◽  
Lei Tang ◽  
Qinqin Yin ◽  
Linghui Yang ◽  
Deying Gong ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Motor Block ◽  
Sensory Block ◽  
Sciatic Nerve Block ◽  
Block Model ◽  
Voltage Gated ◽  
Trpv1 Channels ◽  
Channel Currents

Background and objectiveLong-acting nociceptive-selective regional anesthesia has remained an elusive clinical goal. We aspired to identify a novel compound that would produce nociceptive-selective regional anesthesia through the transient receptor potential vanilloid 1 (TRPV1) channels.MethodsWe designed and synthesized a novel compound (LL-a) that penetrates the cell membrane through TRPV1 channels and binds to voltage-gated sodium channels. The regional anesthetic effect of LL-a was evaluated in a rodent sciatic nerve block model. Electrophysiological recording was applied to test the inhibition of LL-a on voltage-gated sodium channel currents.ResultsLL-a inhibited sodium channel currents on the dorsal root ganglion neurons of mice and this action was diminished by TRPV1 channel knockout. In a sciatic nerve block model of a rat, 0.2% and 0.4% (w/v) LL-a produced selective sensory block with median (IQR) durations of 42.0 (24.0, 48.0) and 72.0 (69.0, 78.0) hours, respectively. No motor block was found for 0.2% LL-a. 0.4% LL-a produced a motor block with a median (IQR) duration of 3.0 (0.0, 6.0) hours. This selective sensory block was not observed on TRPV1 knockout mice. As a positive control, 0.5% and 0.75% levobupivacaine produced a non-selective sciatic nerve block with median (IQR) durations of 2.8 (2.6, 2.8) and 3.8 (3.8, 4.8) hours, respectively. No systemic or local irritation was observed during injection of LL-a and sensory and motor function completely recovered for all the animals.ConclusionsLL-a is a potential novel local anesthetic for long-lasting nociceptive-selective 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.

scholarly journals NEOSTIGMINE

2016 ◽  
Vol 23 (07) ◽  
pp. 780-783
Author(s):  
Aamir Furqan ◽  
Adnan Aslam ◽  
Afifa Zahoor
Keyword(s):  
Data Analysis ◽  
Standard Deviation ◽  
Motor Block ◽  
Sensory Block ◽  
Rapid Onset ◽  
Control Group ◽  
Microsoft Excel ◽  
Intravenous Regional Anesthesia ◽  
Trial Setting

Objectives: To compare the effect of Neostigmine as an Adjunct to 0.5%Lignocaine for increasing the duration of anesthesia and analgesia. Study Design: Randomizedcontrolled trial. Setting: Department of Anesthesiology, Nishtar Hospital, Multan. Period: January20014 to January 2015. Material and Methods: One hundred (100) patients were selected forthis study. Microsoft Excel 2013 was used for data analysis. Frequacy and percentage wereused to present categorical varibales and mean+standard deviation for numerical variables.Results: There was a rapid onset of Sensory and motor blocks in neostigmine group, 3.9+2.5minutes for sensory block and 5.8+2.3 minutes for motor block versus 9.3+2.2 minutes and13.3+2.0 minutes respectively in control group. The time of recovery of sensory and motorblocks was delayed in neostigmine group as compared to the control group patients. Thesurgeons agreed that the anesthesia was perfect in 46 (92.0%) cases in neostigmine groupand in control group IVRA declared to be perfect in only 34 (68.0%) cases. Dryness of operativefield was same between the two groups. Conclusion: The addition of neostigmine in lignocainesolution for intravenous regional anesthesia improves the quality of anesthesia and analgesia.

scholarly journals Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

2021 ◽  
Author(s):  
Moumita Roychowdhury ◽  
Anjum Naz
Keyword(s):  
Patient Satisfaction ◽  
Regional Anesthesia ◽  
Rating Scale ◽  
Controlled Study ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Upper Limb Surgery ◽  
Fentanyl Consumption ◽  
Group B ◽  
Preservative Free

Objective: Intravenous regional anesthesia (IVRA) is an effective anesthetic technique for surgical procedures of short duration involving the distal parts of the limbs. Intraoperative tourniquet pain is the major restraint of this technique, and to overcome this limitation, various adjuvants to local anesthetics have been used. This study investigated the effect of a fixed low dose of dexmedetomidine as an adjuvant to lignocaine on intraoperative tourniquet pain, onset of block, duration of block, and patient satisfaction. Methods: A total of 100 adult patients with ASA grade I and II who were scheduled for upper limb surgery of approximately 1 hour in duration were randomly divided into two groups (n=50 in each group). Group A received 35 mL of preservative-free lignocaine alone and Group B received 35 mL of preservative-free lignocaine along with 30 μg of dexmedetomidine. The incidence of tourniquet pain, intraoperative fentanyl consumption, duration of onset and recovery of sensory and motor block after tourniquet deflation, postoperative numeric pain rating scale (NPRS) scores, duration of analgesia, and overall patient satisfaction were noted. Result: The incidence of tourniquet pain and intraoperative fentanyl consumption were significantly lower in Group B. The onset and duration of sensory and motor blocks were faster and longer, respectively, in Group B. Postoperative NPRS scores were lower, duration of analgesia was longer, and overall patient satisfaction was better in the dexmedetomidine group. Conclusion: Dexmedetomidine at a dose of 30 μg as a lignocaine adjuvant significantly reduces tourniquet pain and intraoperative fentanyl consumption in IVRA. Dexmedetomidine shortens the onset of block, prolongs the duration of block, and provides a more satisfactory anesthesia than lignocaine alone.

scholarly journals Evaluation of the Efficacy of Magnesium Sulphate as an Adjuvant to Lignocaine for Intravenous Regional Anaesthesia for Upper Limb Surgery

2008 ◽  
Vol 36 (6) ◽  
pp. 840-844 ◽  
Author(s):  
S. Narang ◽  
J. S. Dali ◽  
M. Agarwal ◽  
R. Garg
Keyword(s):  
Upper Limb ◽  
Normal Saline ◽  
Magnesium Sulphate ◽  
Regional Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Tourniquet Pain ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Intravenous Regional Anaesthesia

Several additives have been combined with local anaesthetics for intravenous regional anaesthesia to improve block quality, analgesia and to decrease tourniquet pain. Magnesium sulphate is one potential additive. This prospective, randomised, double-blinded study was conducted in 30 ASA physical status I or II patients undergoing upper limb surgery under tourniquet. In group L, patients received intravenous regional anaesthesia with lignocaine alone (9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Patients in group M received intravenous regional anaesthesia with lignocaine plus magnesium sulphate (6 ml of 25% magnesium sulphate plus 9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Assessment was by observing the response to injection of drug; sensory and motor block and tourniquet pain. The mean time of onset of sensory block was 12.40 and 3.47 minutes in groups L and M respectively (P <0.001). The average times of onset of motor block in groups L and M were 17 and six minutes respectively (P <0.001). Of the patients in group M, 66.7% reported moderate to severe pain while the drug was being injected, compared to 20% in group L (P=0.011). There was a statistically significant difference in visual analogue scale for tourniquet pain at 10 and 30 minutes after tourniquet inflation (lower in group M). These findings indicate that magnesium sulphate added as an adjuvant to lignocaine hastens the onset of sensory and motor block and decreases tourniquet pain. However, there is increased incidence of transient pain on injection if magnesium sulphate is added.

Sign in / Sign up

Export Citation Format

Share Document