Comparison of Two Different Concentrations for Foot and Ankle Surgeries During Intravenous Regional Anesthesia (IVRA): A Randomized Cohort Study

Year 2022, , 263 - 268, 30.12.2022

Ergun Mendes , Elzem Sen , Mehmet Cesur , Hüseyin Göçergil , Yusuf Emeli , Sıtkı Göksu

https://doi.org/10.18678/dtfd.1108347

Abstract

Aim: Intravenous regional anesthesia (IVRA) is not commonly preferred in the lower extremity because of the toxic risks of high-dose local anesthetics. This study aimed to compare the use of two different concentrations of anesthetics with additional tourniquet application to reduce local anesthetics amount during the IVRA method for short-term foot and ankle surgeries.
Material and Methods: In this prospective study, 40 patients were allocated to two groups with different concentration formulations of 200 mg lidocaine hydrochloride (Group 30 and Group 20). The groups were compared in terms of demographic data, tourniquet pain, operation time, hemodynamic indicators, and sedo-analgesia needs.
Results: Demographic data were similar in the two groups. The mean tourniquet pain time was 41.66±6.61 minutes in Group 20 (n=9) and 36.76±7.17 minutes in Group 30 (n=13) (p=0.120). Perioperative sedo-analgesia consumptions were similar between the groups: weight-adjusted before/after tourniquet pain (p=0.390, p=0.207, p=0.536, and p=0.176), weight-adjusted/none total amount (p=0.425, p=0.578, p=0.268, and p=0.612), per minute before/after tourniquet pain (p=0.075, p=0.506, p=0.354, and p=0.055), for propofol and remifentanil, respectively. There was a significant difference between the propofol and remifentanil consumption per minute before and after the tourniquet pain in both groups: 5.61±1.67 and 14.58±6.62 mg/min propofol (p=0.001), and 4.79±1.69 and 7.86±1.55 mcg/min remifentanil (p=0.001), respectively. No patient had signs of local anesthetic toxicity.
Conclusion: Low-dose sedo-analgesia can be used by a modified IVRA method in the management of tourniquet discomfort that may occur until the tourniquet pain develops.

Keywords

intravenous regional anesthesia, additional tourniquet, short-term foot and ankle surgery, tourniquet pain, lower extremity

İntravenöz Rejyonel Anestezi (IVRA) Sırasında Ayak ve Ayak Bileği Ameliyatları için İki Farklı Konsantrasyonun Karşılaştırılması: Randomize Kohort Çalışma

Abstract

Amaç: Intravenöz rejyonel anestezi (IVRA), yüksek doz lokal anesteziklerin toksik riskleri nedeniyle alt ekstremitede yaygın olarak tercih edilmemektedir. Bu çalışmada, kısa süreli ayak ve ayak bileği ameliyatlarında IVRA yöntemi sırasında lokal anestezik miktarını azaltmak için iki farklı anestezik konsantrasyonunun ek turnike uygulaması ile karşılaştırılması amaçlandı.
Gereç ve Yöntemler: Bu prospektif çalışmada, 40 hasta 200 mg lidokain hidroklorürün farklı konsantrasyon formülasyonlarına sahip iki gruba ayrıldı (Grup 30 ve Grup 20). Gruplar demografik veriler, turnike ağrısı, operasyon süresi, hemodinamik göstergeler ve sedo-analjezi ihtiyaçları açısından karşılaştırıldı.
Bulgular: Demografik veriler her iki grupta da benzerdi. Turnike ağrı süresinin ortalaması Grup 20'de (n=9) 41,66±6,61 dakika ve Grup 30'da (n=13) 36,76±7,17 dakika idi (p=0.120). Perioperatif sedo-analjezi tüketimleri gruplar arasında benzerdi: propofol ve remifentanil için sırasıyla, kiloya göre turnike ağrısı önce/sonra (p=0,390; p=0,207; p=0,536 ve p=0,176), kiloya göre/yok toplam miktar (p=0,425; p=0,578; p=0,268 ve p=0,612), dakika başına turnike ağrısı önce/sonra (p=0,075; p=0,506; p=0,354 ve p=0,055). Her iki grupta da turnike ağrısı öncesi ve sonrası dakika başına propofol ve remifentanil tüketimi arasında önemli bir fark vardı: sırasıyla, 5,61±1,67 ve 14,58±6,62 mg/dk propofol (p=0,001) ve 4,79±1,69 ve 7,86±1,55 mcg/dk remifentanil (p=0,001). Hiçbir hastada lokal anestezik toksisite bulguları yoktu.
Sonuç: Düşük doz sedo-analjezi, turnike ağrısı gelişene kadar oluşabilecek turnike rahatsızlığının tedavisinde modifiye bir IVRA yöntemi ile kullanılabilir.

Keywords

rejyonel intravenöz anestezi, ek turnike, kısa süreli ayak ve ayak bileği cerrahisi, turnike ağrısı, alt ekstremite

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