A Comparative Study on the Effects of Clonidine Plus Lignocaine, Tramadol Plus Lignocaine and Plain Lignocaine for Intravenous Regional Anesthesia (original) (raw)
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Journal of evolution of medical and dental sciences, 2013
INTRODUCTION: IVRA is a simple, reliable, and effective technique with rapid onset of action, rapid and prompt recovery after tourniquet release. It provides good analgesia, adequate muscle relaxation, & bloodless operative field. It is widely applicable to patients of different ages and physical status for operations & cost effective. Lignocaine though preferred local anesthetic agent has limitation of short duration of anesthesia & inability to provide postoperative analgesia various additives were added to it. In this study we compared efficacy of clonidine as an adjuvant to lignocaine with plain Lignocaine. MATERIAL & METHOD: Patients undergoing upper arm surgery were included in this study & are divided in two groups. The proximal circulatory isolation of arm was done by placing a pneumatic tourniquet around arm. In group C IVRA was given by 1ug/kg clonidine & 0.5% preservative free lignocaine in a dose of 200mg diluted up to 40 ml & in group L 0.5% preservative free lignocaine 200 mg diluted up to 40 ml. Tourniquet was deflated at least 30 mines after injection of drug. AIMS & OBJECTIVES: To compare onset and quality of sensory analgesia, Onset and quality of motor blockade, onset & severity of tourniquet pain, Complications like hypotension &bradycardia during the procedure, recovery from sensory and motor blockade duration of Postoperative analgesia in group C with group L. CONCLUSION: We observed that using Clonidine in dose of 1 ug/kg as an adjuvant to Lignocaine in IVRA does not have early onset of sensory blockade, increased tourniquet tolerance, delayed tourniquet pain and extended post-operative analgesia .Neither systemic side effects like nausea, bradycardia, hypotension, convulsion nor local complications like hematoma were observed. INTRODUCTION: Intravenous regional anaesthesia was originally introduced by the German surgeon August K. G. Bier 1 in 1908; thus the name, "Bier block". Dr. Bier described a complete anaesthesia and motor paralysis after intravenous injection of Prilocaine into a previously exsanguinated limb. It is a simple, reliable, and effective technique with rapid onset of action, and prompt recovery after tourniquet release. It provides good analgesia, adequate muscle relaxation, & bloodless operative field, widely applicable to patients of different ages and physical status for operations & cost effective. Poor postoperative analgesia, limited duration of anaesthesia (<90 minutes), the potential for local anesthetic toxicity, nerve damage and compartment syndrome are the disadvantages of intravenous regional anaesthesia.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Intravenous regional anaesthesia for forearm and hand surgeries, which is one of the safe, cost-effective and rapid onset anaesthesia is less popular nowadays, because of its lesser postoperative analgaesia and tourniquet pain. Aim: To compare dexmedetomidine and clonidine as an adjuvant to 0.5% lignocaine to study block characteristics, tourniquet pain and postoperative analgaesia in forearm and hand surgeries. Materials and Methods: This randomised clinical trial was conducted in Acharya Vinoba Bhave Rural Hospital (Tertiary Care Hospital), Wardha, Maharashtra, India, from September 2019 to September 2021 on 70 patients posted for forearm and hand surgeries. The patients were divided into two groups of 35 each. Group C received clonidine 1 mcg /kg with 40 mL of 0.5% lignocaine preservative free. Group D received dexmedetomidine 1 mcg /kg with 40 mL of 0.5% lignocaine preservative free. Independent samples t-test was used for evaluation of demographic data, haemodynam...
Journal on Recent Advances in Pain, 2018
Objective: Intravenous regional anesthesia (IVRA) is used for short procedures for hand and upper limb surgeries. In terms of analgesia duration and quality of anesthesia, IVRA with adjuvants like opioids, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs) increases the efficacy. We conducted this comparative study for evaluating the effect of adding magnesium sulfate and clonidine with lignocaine in IVRA for upper limb surgeries. Materials and methods: Seventy-five patients with American Society of Anesthesiologists (ASA) class I and II of either sex, age 18 to 60 years, undergoing upper limbs surgeries were enrolled. They were divided into three groups (25 each) according to drug received. Group L: 9 mL of 2% lignocaine (preservative-free) diluted with normal saline to make a total volume of 36 mL of 0.5% lignocaine. Group M: 3 mL of 50% magnesium sulfate with 9 mL of 2% lignocaine diluted with normal saline to make total volume of 36 mL, 0.5% lignocaine. Group C: 1 µg/kg clonidine with 9 mL of 2% lignocaine diluted with normal saline to make total volume of 36 mL of 0.5% lignocaine. Sensory and motor block (onset and recovery time), intraoperative tourniquet pain, first tramadol requirement time and mean tramadol dosage, quality of operative conditions, hemodynamic parameters, postoperative pain scores [in visual analog scale (VAS)] were recorded. Results: Both groups were comparable in terms of age, sex, ASA grade, baseline hemodynamic parameters, duration of surgery, and tourniquet inflation time. Shortened sensory and motor block onset times were established in M group (p < 0.05). Recovery from sensory and motor blockade was significantly prolonged in M group (p < 0.05). Anesthesia excellence as determined by anesthesiologist and surgeon was significantly better in C group as compared with rest of the two groups (p < 0.05). There was statistically significant difference (p > 0.05) in intraoperative VAS scores in groups M and C as compared with group L, throughout the procedure. Time to first analgesic requirement in group C was 43.04 ± 27.46 minutes, group M
Objectives: Intravenous regional anesthesia is used for short procedures for hand and upper limb surgeries. IVRA with adjuvants like opioids, muscle relaxants, NSAIDS increases the efficacy in terms of analgesic duration and quality of anesthesia. We conducted this comparative study for evaluating the effect of adding magnesium sulphate and clonidine with lignocaine in IVRA for upper limb surgeries. Methodology: Seventy five patients ASA class 1 and 2 of either sex, age 18-60 years undergoing upper limbs surgeries were enrolled. They were divided into three groups (25 each) according to drug received. Group L: 9 ml of 2% lignocaine (preservative free) diluted with normal saline to make a total volume of 36 ml of 0.5% lignocaine. Group M: 3 ml of 50% magnesium sulphate with 9 ml of 2 % lignocaine diluted with normal saline to make a total volume of 36 ml, 0.5% lignocaine. Group C: 1 µg/kg clonidine with 9 ml of 2% lignocaine diluted with normal saline to make a total volume of 36 ml of 0.5% lignocaine. Sensory and motor block (onset and recovery time), intraoperative tourniquet pain, time to first tramadol requirement and mean tramadol dosage, quality of operative conditions, hemodynamic parameters, postoperative pain (VAS) scores were recorded. Results: Both groups were comparable in terms of age, sex, ASA grade, baseline hemodynamic parameters, duration of surgery and tourniquet inflation time. Shortened sensory and motor block onset times were established in Group M (p < 0.05). Recovery from sensory and motor blockade was significantly prolonged in Group M (p < 0.05). Anesthesia excellence as determined by anesthesiologist and the surgeon was significantly better in C group as compared to rest two groups(p<0.05). There was statistically significant difference (p>0.05) in intraoperative VAS in group M and C as compared to group L, throughout the procedure. Time to First analgesic requirement in group C 43.04±27.46, group M 42.72±18.06 and group L was 27.08±4.45 minutes(p<0.05). Postoperative VAS scores for 24hours were higher in group L as compared to group M and C (p<0.05). Conclusion: Magnesium sulphate as an adjuvant to lignocaine hydrochloride for IVRA for upper limb surgeries shorten the onset of sensory and motor block to greater extent as compared to clonidine and lignocaine alone though postoperative analgesia was found to be of longer duration with clonidine as an adjuvant. Citation: Solanki D, Singh M, Intravenous regional anesthesia: comparing efficacy of magnesium sulphate and clonidine as an adjuvant to lignocaine for intraoperative and postoperative analgesia. Anaesth Pain & Intensive Care 2018;22(1):48-54
Objectives: Intravenous local anesthesia remains applied for brief techniques for hand in addition to upper limb operations. IVRA including adjuvants like opioids, muscle relaxants, NSAIDS raises effectiveness in conditions of analgesic period as well as excellence of anesthesia. Researchers led the current relative research for assessing consequence of increasing magnesium sulphate in addition clonidine by lignocaine in IVRA for superior limb operations. Methodology: Our current research was conducted at Mayo Hospital Lahore from July 2017 to June 2010. Eightyone cases ASA class 1 besides 2 of any gender, age 19-62 years experiencing upper limbs operations remained registered. Respondents remained distributed into 3 groups (27 for each) agreeing to medication obtained. Set L: 10 ml of 3% lignocaine (additive free) attenuated along with usual saline to produce the overall volume of 38 ml of 0.6% lignocaine. Set M: 4 ml of 53% magnesium sulphate along with 10 ml of 3 % lignocaine dilute through usual saline to produce the overall capacity of 38 ml, 0.6% lignocaine. Set C: 2 μg/kg clonidine by 10 ml of 3% lignocaine dilute along with usual saline to produce the overall capacity of 38 ml of 0.6% lignocaine. Sensory plus motor block (beginning as well as healing time), intraoperatively strap discomfort, period to initial tramadol necessity in addition to average tramadol quantity, excellence of operational situations, hemodynamic limitations, postoperatively discomfort points remained verified. Results: Mutually both sets remained equivalent in conditions of age, gender, ASA class, standard hemodynamic limitations, period of operation along with tourniquet increase time. Reduced sensory along with motor block beginning times remained recognized in set M (p < 0.06). Anesthesia superiority as established by means of anesthesiologist in addition to physician remained substantially improved in C set as related to remainder 2 sets (p<0.06). Here remained statistically substantial variation (p>0.06) in intraoperative VAS in set M as well as C as related to set L, all over technique. Time to Initial analgesic necessity in set C 44.05±28.47, set M 43.74±19.07 as well as set L remained 28.09±5.46 mins(p<0.06). Postoperatively VAS scores for 1 day remained better in set L as associated to set M in addition to C (p<0.06). Conclusion: Magnesium sulphate by means of an adjuvant to lignocaine hydrochloride for IVRA for higher limb operations diminish beginning of sensory in addition to motor block to larger magnitude as related to clonidine along with lignocaine only even though postoperatively analgesia remained discovered to occur for lengthier period laterally through clonidine by way of an adjuvant.
Journal of Evolution of medical and Dental Sciences, 2015
INTRODUCTION: Intravenous regional anesthesia is simple, effective technique for upper limb orthopedic surgeries however adjuncts are required to improve its efficacy. AIMS: To compare the effects of adding paracetamol and tramadol as adjunct to lignocaine in intravenous regional anesthesia on onset and regression of sensory and motor blockage, analgesic requirements, duration of analgesia and side effects. PATIENTS AND METHOD: A randomized study was carried out on ninety patients who were undergoing upper limb orthopedic surgery, divided in to three groups: group I (L) received 3mg/kg lignocaine 0.5% diluted up to 40 ml with normal saline, group II (LP) received 3mg/kg lignocaine 0.5% with 300mg paracetamol diluted up to 40 ml with normal saline, group III (LT) received 3mg/kg lignocaine 0.5% with tramadol 100mg diluted up to 40 ml with normal saline. Sensory and motor block onset, regression time, intraoperatively and postoperatively VAS score, duration of analgesia, total analges...
Journal of Anesthesiology and Reanimation Specialists’ Society, 2021
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 sens...
International Journal of Medical Research Professionals, 2016
Introduction: Intra venous Regional Anaesthesia is one of the best procedures, providing better intra operative hemodynamic control, post-operative pain relief and rapid recovery from surgery specially upper and lower limb general and orthopedic surgeries. The purpose of the study was to evaluate the efficacy and superiority combination of Lignocaine & Bupivacaince over the any of the drug if used alone and also investigate prolong postoperative pain relief and reduce the requirement of rescue analgesia in upper and lower limb with least side effects.. Intravenous regional Analgesia (I.V.R.A) is simple, effective, economic and safe method of pain relief during limb surgery. Each patient was premeditated with Fentanyl 1 mcg/kg, I.V.Phenargan (0.5 mg / kg, I.V. Medazolam 1 mg I.V was given slowly intravenously 15 minutes earlier to surgery. Material and Methods: In our randomized control trial study, total 60 ASA class I and II patients of age between 15 to 65 years undergoing lower and upper limb orthopedic and other surgeries were given. Patients received 0.5% lignocaine 20 ml to 40 ml alone in one group A and groups B received 40ml to 60 ml of 0.5% of bupvacaine and group C received combination of lignocaine and Bupivacaine 0.5% respectively. All the patients were monitored for onset of sensory and motor blockade, intra operative hemodynamic, post-operative analgesia, adverse effect and complications. Results: Onset of sensory and motor blockade was early in group C. Addition of Bupivacaine with Lignocaine increases the post-operative pain free period significantly and the incidences of complications start to appear in Group A. The incidence of side effects like hypotension, Bradycardia and shivering were not seen in patients of group C. Group A patients receiving Lignocaine 0.5% had hypotension (5%), tachycardia (5%), shivering (0%), vomiting (5%) and convulsion (5%). Group B had rigor in 5 % of the patients and Group C patient had no complication. Conclusion: Addition of Lignocaine with Bupivacaine prolongs postoperative analgesia without altering block characteristics with no side effects and appears to be safe and reliable adjuvant to each other.
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objective: Objective of this trial was to study time of onset, duration of sensory & motor blockade and quality of anaesthesia by addition of dexmedetomidine to local anaesthetic solution in Intravenous Regional Anaesthesia (IVRA) in upper extremity orthopaedic surgeries. Methods: This was a prospective, randomized and double blind clinical trial. Ninety American Society of Anaesthesiologists Grade I and II patients of either gender between 18 and 60 years of age scheduled for elective upper extremity orthopedic surgeries lasting for <90 min were included in the study. Patients were randomly allocated to two Groups A and B of 45 each. Group A received 3 mg/kg preservative free lignocaine alone and Group B received 3 mg/kg preservative free lignocaine with dexmedetomidine, 0.5 µg/kg in IVRA. Result: Onset time of sensory blockade in Group A and B was 5.6±0.93 min and 3.9±0.63 min respectively. Onset time of motor blockade in Group A and Group B was 15.01±4.53 min and 10.74±3.64 min respectively. The difference in onset time of sensory and motor blockade between the two groups was statistically significant (p<0.05). Sensory blockade recovery time after release of tourniquet was 6.9±0.53 min in Group A and 29.21±5.23 min in Group B. Motor blockade recovery time was 4.35±0.76 min for Group A and 12.32±7.23 min for Group B. The difference in sensory and motor blockade recovery time between the two groups was statistically significant (p<0.05). Conclusion: Dexmedetomidine on addition to lignocaine for IVRA provided rapid onset of sensory and motor blockade, prolonged duration of sensory & motor blockade and reduced tourniquet pain.