Rejyonal intravenöz anestezi tekniğinde lidokain’e deksametazon ve deksketoprofen eklenmesinin anestezi ve postoperatif analjeziye etkisi

Year 2021, Volume: 4 Issue: 1, 1 - 11, 08.06.2021

Osman Çiçekler İbrahim Gümüş Taylan Akkaya

Abstract

Amaç: RİVA; ameliyat sonrası komplikasyonların az olması, maliyetinin düşük olması, kolay uygulanabilmesi, tekniğin kolaylığı nedeniyle sık tercih edilen bir yöntemdir. Çalışmamızda; RİVA uygulamasında lidokaine deksametazon ve deksketoprofen eklenmesinin hemodinami, analjezi, perioperatif anestezi ve analjezi kalitesi, postoperatif analjezi süresi ve analjezik kullanım miktarları açısından karşılaştırılmasını amaçladık.
Yöntem: Çalışmamıza üst ekstremite cerrahisi uygulanacak 18 yaş üstü, ASA I-III grubu 56 hasta dahil edildi. Olgular üç gruba ayrılarak Grup-I’ e 3 mg/kg lidokain; Grup-II’ ye 3 mg/kg lidokain+ 8 mg deksametazon; Grup-III’ e ise 3 mg/kg lidokain+ 8 mg deksametazon+ 50 mg deksketoprofen verilerek RİVA uygulandı.
Bulgular: Gruplar arasında demografik özellikler açısından istatistiksel olarak fark yoktu. Sensoryal blok başlama ve sonlanma süreleri gruplarda benzerdi. Motor blok başlama zamanı Grup III’ de diğerlerinden daha kısaydı ve fark istatistiksel olarak anlamlı bulundu. Motor blok sonlanma süreleri gruplar arasında benzerdi. İntraoperatif ve postoperatif sedasyon değerleri üç grupta da farklı değildi. Anestezi kalitesi intraoperatif 20. dakikada Grup I’de diğerlerinden daha düşük bulundu. Fentanil gereksinimi açısından gruplar arasında fark saptanmadı.
Postoperatif dönemde Grup I’ in VAS skorları tüm zamanlarda diğer gruplardan daha yüksekti. Analjezik kullanan hasta sayısı grup III’ de diğerlerinden anlamlı olarak daha azdı. Grup III’ te toplam analjezik tüketimi en azdı ve ilk analjezik alım zamanı en uzundu.
Sonuç: Sonuç olarak lidokaine deksametazon ve deksketoprofen eklenmesi ile daha kaliteli anestezi, postoperatif analjezi sağlanabileceğini ve postoperatif analjezik tüketiminin azaltılabileceğini düşünmekteyiz.

Keywords

RİVA, deksametazon, deksketoprofen, postoperatif analjezi

The Effect of Adding Dexamethasone and dexketoprofen to lidocaine in anesthesia and postoperative analgesia as a regional intravenous anesthesia technique

Abstract

Aim: RIVA is an often preferred method due to low number of post-operative complications, low costs, ease of application and lack of technical challenges. In our study, we aimed to compare supplementation of lidocaine with dexamethasone and dexketoprofen in RIVA technique in terms of perioperative anesthesia and analgesia technique, duration of post-operative analgesia and volume of analgesic administered.
Method: Fifty six patients to undergo upper extremity surgery, who were aged over 18 years and were included in ASA I-III group, were enrolled to the present study. RIVA was applied by administering 3 mg/kg lidocaine to Group I, 3 mg/kg lidocaine+8 mg dexamethasone to Group II and 3 mg/kg lidocaine + 8 mg dexamethasone + 50 mg dexketoprofen to Group III.
Results: There was no statistical difference between study groups in terms of demographic features. Time for onset and duration of sensorial block was similar among groups. Onset of motor block was shorter in Group III relative to other groups and it was found that the difference was significant. Duration of motor block was similar among groups. Intraoperative and post-operative sedation values did not vary among three groups. Anesthesia quality was found lower at 20th minute in Group I in comparison with that of other groups. No difference was found between groups in terms of phentanyl requirement.
In post-operative period, VAS scores of Group I was higher than that of other groups at all time points. Number of patients receiving analgesic was significantly lower in Group III relative to other groups. Total volume of analgesic administered was lowest and time to first dose of analgesic was longer in Group III.
Conclusion: In conclusion, we believe that a better quality anesthesia and postoperative analgesia can be ensured and post-operative analgesic consumption can be reduced by supplementing lidocaine with dexamethasone and dexketoprofen.

Keywords

RIVA, dexamethasone, dexketoprofen, post-operative analgesia

References

• 1. Collins V. Purpose of anaesthesiology: general and regional anesthesia. Philadelphia: Lea and Febiger. 1993:276-80,918.
• 2. Rosenberg PH. Intravenous regional anesthesia: nerve block by multiple mechanisms. Reg Anesth Pain Med. 1993;18(1):1-5.
• 3. Hilgenhurst G. The Bier block after 80 years: a historical review. Regional Anesthesia: The Journal of Neural Blockade in Obstetrics, Surgery, & Pain Control. 1990;15(1):2-5.
• 4. Covino B. The pharmacology of local anesthetic agents. Anesthesiology 1986: Springer; 1986. p. 6-10.
• 5. Barry LA, Balliana SA, Galeppi AC. Intravenous regional anesthesia (Bier block). Techniques in Regional Anesthesia and Pain Management. 2006;10(3):123-31.
• 6. Koyyalamudi V, Sen S, Patil S, Creel JB, Cornett EM, Fox CJ, et al. Adjuvant agents in regional anesthesia in the ambulatory setting. Current pain and headache reports. 2017;21(1):6.
• 7. Yektaş A, Gümüş F, Karayel A, Alagöl A. Effects of addition of systemic tramadol or adjunct tramadol to lidocaine used for intravenous regional anesthesia in patients undergoing hand surgery. Anesthesiology research and practice. 2016;2016.
• 8. Turan A, Karamanlýoglu B, Memis D, Kaya G, Pamukçu Z. Intravenous regional anesthesia using prilocaine and neostigmine. Anesthesia & Analgesia. 2002;95(5):1419-22.
• 9. Bigat Z, Boztuğ N, Çete N, Hadimoğlu N, Ertok E. RİVA’da lidokain ve lidokain’e eklenen tenoksikam ve deksametazonun karşılaştırılması. Türk Anest Rean Der. 2004;32:200-6.
• 10. Kleinschmidt S, Stöckl W, Wilhelm W, Larsen R. The addition of clonidine to prilocaine for intravenous regional anaesthesia. European journal of anaesthesiology. 1997;14(1):40-6.
• 11. Turan A, Memis D, Karamanlioglu B, Güler T, Pamukçu Z. Intravenous regional anesthesia using lidocaine and magnesium. Anesthesia & Analgesia. 2005;100(4):1189-92.
• 12. Bigat Z, Boztug N, Hadimioglu N, Cete N, Coskunfirat N, Ertok E. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study. Anesthesia & Analgesia. 2006;102(2):605-9.
• 13. Jankovic R, Visnjic M, Milic D, Stojanovic M, Djordjevic D, Pavlovic M. Does the addition of ketorolac and dexamethasone to lidocaine intravenous regional anesthesia improve postoperative analgesia and tourniquet tolerance for ambulatory hand surgery. Minerva Anestesiol. 2008;74(10):521-7.
• 14. Mauleón D, Artigas R, García ML, Carganico G. Preclinical and clinical development of dexketoprofen. Drugs. 1996;52(5):24-46.
• 15. HOFFMANN A, VAN GESSEL E, GAMULIN Z, RYSER J, FORSTER A, Zarmsky R. Quantitative Evaluation of Tourniquet Leak During IV Regional Anaesthesia of the Upper and Lower Limbs in Human Volunteers. Survey of Anesthesiology. 1996;40(6):379.
• 16. Memis D, Turan A, Karamanloglu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesthesia & Analgesia. 2004;98(3):835-40.
• 17. Armstrong P, Watters J, Whitfield A. Alkalinisation of prilocaine for intravenous regional anaesthesia. Suitability for clinical use. Anaesthesia. 1990;45(11):935-7.
• 18. Acalovschi I, Cristea T, Margarit S, Gavrus R. Tramadol added to lidocaine for intravenous regional anesthesia. Anesthesia & Analgesia. 2001;92(1):209-14.
• 19. Esmaoglu A, Mizrak A, Akin A, Turk Y, Boyaci A. Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia1. European Journal of Anaesthesiology (EJA). 2005;22(6):447-51.
• 20. Esmaoglu A, Akin A, Mizrak A, Turk Y, Boyaci A. Addition of cisatracurium to lidocaine for intravenous regional anesthesia. Journal of clinical anesthesia. 2006;18(3):194-7.
• 21. Sen S, Ugur B, Aydın O, Ogurlu M, Gezer E, Savk O. The analgesic effect of lornoxicam when added to lidocaine for intravenous regional anaesthesia. BJA: British Journal of anaesthesia. 2006;97(3):408-13.
• 22. Reuben SS, Steinberg RB, Kreitzer JM, Duprat KM. Intravenous regional anesthesia using lidocaine and ketorolac. Anesthesia & Analgesia. 1995;81(1):110-3.
• 23. Turan KB, Kaya G, Pamukcu Z. Transdermal nitrogliserinin rejyonel intravenöz anestezide etkileri. Trakya Universitesi Tıp Fakultesi Dergisi. 2002;19:100-5.
• 24. Bakanlığı TS, Kırdar L, Anesteziyoloji I. REJYONEL İNTRAVENÖZ ANESTEZİDE LİDOKAİN, LİDOKAİN-TENOKSİKAM VE LİDOKAİN-LORNOKSİKAMIN ETKİNLİKLERİNİN KARŞILAŞTIRILMASI.
• 25. Tuncer S, Barışkaner H, Pirbudak L, Otelcioğlu Ş. Rejyonel intravenöz anestezide prilokain ve prilokain meperidin kombinasyonunun karşılaştırılması. Ağrı Dergisi. 2000;12(3):26-9.
• 26. McCartney CJ, Brill S, Rawson R, Sanandaji K, Iagounova A, Chan VW. No anesthetic or analgesic benefit of neostigmine 1 mg added to intravenous regional anesthesia with lidocaine 0.5% for hand surgery. Regional Anesthesia & Pain Medicine. 2003;28(5):414-7.