Comparison of tramadol and lornoxicam in intravenous regional anesthesia: a randomized controlled trial / Comparação de tramadol e lornoxicam em anestesia regional por via intravenosa, um estudo randomizado e controlado

BACKGROUND AND OBJECTIVES: Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. METHODS: After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n = 17) received 3 mg/kg 0.5% prilocaine; group PT (n = 17) 3 mg/kg 0.5% prilocaine + 2 mL (100 mg) tramadol and group PL (n = 17) 3 mg/kg 0.5% prilocaine + 2 mL (8 mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. RESULTS: Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. CONCLUSION: Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.

JUSTIFICATIVA E OBJETIVOS: A dor relacionada ao torniquete é um dos maiores obstáculos para a anestesia regional intravenosa (ARIV). Nosso objetivo foi comparar tramadol e lornoxicam usados em ARIV em relação aos seus efeitos sobre a qualidade da anestesia, dor relacionada ao torniquete e dor no pós-operatório. MÉTODOS: Após a aprovação do Comitê de Ética, 51 pacientes com estado físico ASA I-II entre 18-65 anos foram inscritos. Os pacientes foram divididos em três grupos. Grupo P (n = 17) recebeu 3 mg/kg de prilocaína a 0,5%; Grupo PT (n = 17) 3 mg/kg de prilocaína a 0,5% + 2 mL (100 mg) de tramadol e Grupo PL (n = 17) de 3 mg/kg de prilocaína a 0,5% + 2 mL (8 mg) de lornoxicam para ARIV. O início do bloqueio sensorial e motor e os tempos de recuperação foram registrados, bem como a dor relacionada ao torniquete e o consumo de analgésico no pós-operatório. RESULTADOS: Os tempos de início do bloqueio sensorial foram mais curtos nos grupos PT e PL, enquanto que os tempos de recuperação correspondentes foram mais longos do que os do Grupo P. Os tempos de início do bloqueio motor nos grupos PT e PL foram menores do que no Grupo P, enquanto que o tempo de recuperação do grupo PL foi maior do que os dos grupos P e PT. O tempo para início da dor relacionada ao torniquete foi menor no Grupo P e maior no Grupo PL. Não houve diferença em relação à dor relacionada ao torniquete entre os grupos. O Grupo PL apresentou o menor consumo de analgésicos no pós-operatório. CONCLUSÃO: A adição de tramadol e lornoxicam à prilocaína para ARIV produz efeitos favoráveis sobre o bloqueio sensorial e motor. O consumo de analgésicos no pós-operatório pode ser reduzido com a adição de tramadol e lornoxicam à prilocaína em ARIV.

Triple drug intravenous regional anesthesia is safe and equally effective (025% lignocaine plus 1 g/kg fentanyl + 05 mg pancuronium) as compared to standard Bier’s block (05% lignocaine)

Intravenous regional anesthesia requires a tiny practice to obtain good results and proves economical. We evaluated the efficacy of fentanyl (1 µg/kg) and pancuronium (0.5 mg) in lower doses with 0.25% lignocaine (1.5 mg/kg) for intravenous regional anesthesia for upper limb surgeries for a period not exceeding one hour, additionally we also compared the above study with standard Bier's block i.e. intravenous regional anaesthesia with 0.5% lidocaine (0.5 mg/kg body weight). This study was conducted in a medical college government general hospital, in Andhra Pradesh over the period of 3 years during 2001 to 2004. Fifty patients belonging to ASA grade I and grade II undergoing upper limb surgery were selected. Patients were included if they were undergoing upper limb surgeries for a period not exceeding one hour. These patients were assigned in a randomized, double fashion to two groups: Group A received 0.6 ml/kg of 0.5 % lidocaine (3 mg/kg) and Group B received 0.6 ml/kg of 0.25 % lidocaine (1.5 mg/kg) plus fentanyl (1 µgm/kg) and pancuronium (0.5 mg). The patients were observed for two hours after the release of the tourniquet for any complications like bradycardia, hypotension, and convulsions etc. The present was compared with standard Bier's block, i.e., 0.5% Bakkireddy Srinivasulu Reddy, P. Narasimha Reddy. Triple drug intravenous regional anesthesia is safe and equally effective (0.25% lignocaine plus 1 µg/kg fentanyl + 0.5 mg pancuronium) as compared to standard Bier's block (0.5% lignocaine). IAIM, 2016; 3(6): 82-87. Page 83 lidocaine (3 mg/kg body weight). Data was presented as Mean±SD, actual numbers and percentages and analyzed using SPSS version 16. In this study, 50 patients undergoing various upper limbs, surgeries were given intravenous regional anesthesia which included 38 males and 12 females. The postoperative analgesia was slightly greater in Group B compared to Group A. The onset of sensory and a motor blockade were earlier in Group A patients when compared to Group B patients. Short delay observed with this new method in the onset of sensory and motor blockade should be noted and the start of surgical procedures delayed until 15-20 minutes after tourniquet inflation. There was no difference in the quality of analgesia and muscle relaxation between two groups. The triple combination of lidocaine, fentanyl and pancuronium can be considered as is safe and effective since the dose of lignocaine can be reduced to a non-toxic level with the same quality of anesthesia. However, the limiting factor in this new technique is a short delay in the onset of sensory and motor blockade compared to standard Bier's block.

Buprenorphine Significantly Prolongs Postoperative Analgesia in Intravenous Regional Anesthesia.

Abstract The current study was conducted to assess the efficacy of buprenorphine as an adjuvant in IVRA with 0.5 % lidocaine on 50 patients aged between 18-65 years, of either sex, scheduled for hand or forearm surgery, who were divided randomly into two groups of 25 each. Group BL- Patients in the group received 10 ml of the preservative free lidocaine 2% diluted with saline, to a total volume of 40ml. Group BBPatients in the group received 10 ml of the preservative free lidocaine 2% mixed with 1ml of buprenorphine 0.3mg diluted with saline to a total volume of 40ml. Various parameters like onset and duration of sensory and motor blockade, degree of intra and postoperative analgesia, and requirement of the postoperative analgesia and occurrence of any complications was noted. The time of onset for sensory block was shorter in group BB (4.0 + 0.35min) as compared to group BL (6.0 + 0.6 min) (p=0.001). The onset of motor block did not differ between the groups (p=0.05). In all patients in group BL analgesic duration did not last for more than 2/3 hours (0.33 + 0.2 hours). In group BB, mean analgesic duration was 6.7 + 1.2 hours. Consumption of Diclofenac was also markedly lower in group BB (80.0 + 9.0mg vs. 214 + 33mg). Addition of buprenorphine as an adjuvant in 0.5% preservative free lidocaine(40 ml volume) significantly improves the postoperative analgesia and it also improved the onset of sensory block. Consumption of Diclofenac was also markedly lower in group BB (80.0 + 9.0 mg vs. 214 + 33 mg).

Comparison of the effects of acetaminophen to ketorolac when added to lidocaine for intravenous regional anesthesia / 대한마취과학회지

BACKGROUND: This study was done to evaluate the effect on pain relief when acetaminophen was added to lidocaine for intravenous regional anesthesia (IVRA). METHODS: Sixty patients undergoing hand or forearm surgery received IVRA were assigned to three groups: Group C received 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml (n = 20), Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml (n = 20) and Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketorolac 10 mg made up to a total volume of 40 ml (n = 20). Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed. RESULTS: Sensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C (P < 0.001). CONCLUSIONS: The addition of acetaminophen to lidocaine for IVRA shortens the onset time of sensory block and delays tourniquet pain onset time, but not with ketorolac. Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.

The Effects of Neostigmine added to Ropivacaine for Intravenous Regional Anesthesia / 대한마취과학회지

BACKGROUND: Neostigmine has been added to local anesthetic regimen for epidural or intrathecal block, and this resulted in prolonged and improved analgesia, but evidence of its benefit in intravenous regional anesthesia (IVRA) is controversial. The purpose of this study was to evaluate the effects of neostigmine added to ropivacaine for IVRA. METHODS: Forty patients undergoing hand or forearm surgery were randomly assigned to two groups to receive IVRA: Group I received 40 ml of 0.2% ropivacaine plus 1 ml of normal saline, and group II received 40 ml of 0.2% ropivacaine plus 500microgram (1 ml) of neostigmine. Sensory block onset time, postoperative visual analogue scale (VAS) scores, recovery time from motor block after deflation, mean arterial pressure (MAP), heart rate (HR), and pulse oximeter saturation (SpO2) values were measured. The incidence of side effects was recorded. RESULTS: Group II had a shorter sensory block onset time, a prolonged motor block recovery time, and lower postoperative VAS scores. No significant difference was found between the two the groups in terms of MAP, HR, SpO2 and side effects. CONCLUSIONS: The addition of neostigmine to ropivacaine in IVRA is believed to be a useful effective method for outpatient arm surgery due to a shortened sensory onset time and improved postoperative analgesia.

Intravenous Regional Anesthesia Using Mepivacaine and Tramadol / 대한마취과학회지

BACKGROUND: Tramadol, an opioid n receptor agonist and monoaminergic reuptake inhibitor, has been studied as an adjunct to general and regional anesthesia. Tramadol has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The purpose of this study was to evaluate the effectiveness of using tramadol as a component of intravenous regional anesthesia (IVRA) to enhance postoperative analgesia. METHODS: Thirty-six patients undergoing hand surgery received IVRA with mepivacaine 0.5%, and were assigned randomly and blindly to one of the following groups: Group I (n = 12) received only 0.5% mepivacaine 40 ml, Group II (n = 12) was given 0.5% mepivacaine 40 ml and 50 mg tramadol, and Group III (n = 12) received 0.5% mepivacaine 40 ml and 100 mg tramadol. After the completion of the operations, analgesic effects were evaluated by using the visual analogue scale (0 - 10). Sedation scores (0 - 3), supplemental analgesic use, and side effects were also evaluated. RESULTS: Patients who received IVRA with 100 mg tramadol reported a significantly lower pain score after tourniquet deflation compared with other groups, and a decreased need for analgesics in the postanesthesia care unit. No significant postoperative sedation, nausea, vomiting, or headache developed in any of the patients. CONCLUSIONS: The addition of 100 mg tramadol to 0.5% mepivacaine for IVRA provided improved analgesia in the postanesthesia care unit after the operation and decreased the need for analgesic supplements after the operation.