Résumé
Background: the effects of the addition of fentanyl or tramadol to a combination of lidocaine and bupivacaine on the quality of supraclavicular brachial plexus block [BPB] were evaluated
Methods: sixty patients scheduled for upper limb surgery were randomized into three equal groups [n=20]. The control group [C] received 20 ml 0.5% bupivacaine plus 10 ml 2% lidocaine for BPB, whereas the other groups received 20 ml 0.25% bupivacaine, 10 ml 2% lidocaine, plus either 100 ug fentanyl [group F] or 100 mg tramadol [group T]. The injected volume was completed to 40 ml using normal saline in all groups. Onset times of sensory block [analgesia and anesthesia] and motor block [paresis and paralysis], total times of surgery, analgesia, anesthesia, and motor block were recorded. Patients and surgeons satisfaction with the blockade, and the occurrence of adverse events were noted
Results: onset times of analgesia, anesthesia, paresis, and paralysis were comparable in the studied groups. The duration of analgesia in group F [16.4 [0.9] h] was comparable to that in group C [15.6 [0.8] h], and both were significantly longer than in group T [12.8 [1.2] h; P <0.05]. A significantly shorter duration of anesthesia was found in group F [7.8 [1.4] h] as compared with group C [9.3 [1.3] h], and in group T [6.7 [2.1] h] as compared with the other groups [P <0.05]. Group F and group T were associated with comparable duration of motor block [6.3 [0.7] h and 5.8 [1.2] h, respectively], and both were significantly less than in group C [8.5 [1] h; P <0.05] All groups were comparable regarding patients and surgeons satisfaction with the blockade, and incidence of adverse events [nausea and vomiting; one patient in group C, and shoulder pain; one patient in group T]
Conclusion: the addition of fentanyl to a lidocaine low dose bupivacaine Combination for supraclavicular BPB achieved comparable analgesic efficacy with that of a lidocaine - high dose bupivacaine combination, with a faster recovery of motor power. Although its analgesic efficacy was not parallel to that of fentanyl, tramadol provided fair duration of analgesia, with no difference from the other groups regarding the overall satisfaction of patients and surgeons with the quality of blockade
Résumé
Epinephrine infiltration is a common practice in ENT operations to produce haemostasis its concomittant administration with inhalational anaesthetics carries the risk to develop cardiac arrhythmias. This study was conducted to assess the cardiovascular stability after epinephrine propranolol-lidocaine infiltration in patients undergoing septoplasty operation under nitrous oxide nalbuphine relaxant technique. Forty ASA I adult patients of either sex were randomly allocated into two groups each of 20. Both groups received nitrous oxide [66%] in oxygen supplemented with nalbuphine 0.2 mg kg using atracurium 0.5 mg kg as the nuscle relaxant during maintenance of anaesthesia. First group received lidocaine 100 mg i.v. prior to infiltration of the nasal septum while the second group received nothing. infiltration of the nasal septum was done 10 minutes after intubation using 4 -5 ml of a solution containing epinephrine 1,00.000. lidocaine 1% plus propranolol 0.1 mg/ml. Patients were monitored as regards heart rate. systolic and diastolic blood pressures. Results showed insignificant changes in heart rate and blood pressure. No ventricular arrhythmias were seen. Lidocaine group showed more cardiovascular stability, in conclusion, epinephrine propranolol and lidocaine infiltration is almost safe during nitrous oxide opioid anaesthesia and lidocaine administration prior to infiltration confers upon more cardiovasculary stability