The Usage of Low-Dose Lidocaine Fentanyl in Intravenous Regional Anesthesia

Abdulmenap Guzel; Feyzi Celik; Öznur Uludag; Erdal Dogan; Celil Alemdar; Besir Yildirim

The Usage of Low-Dose Lidocaine Fentanyl in Intravenous Regional Anesthesia

Year 2013, Volume: 6 Issue: 2, 96 - 99, 01.06.2013

Abdulmenap Guzel Feyzi Celik Öznur Uludag Erdal Dogan Celil Alemdar Besir Yildirim

Abstract

We aimed to present our IVRA practices by adding low-dose lidocaine fentanyl for the patients who have undergone forearm and hand surgery. After approval Ethics Committee and the permission of patients, 36 patients which were undergone elective, forearm or hand surgery, aged 18-60 years, were included in the study. The intravenous route was opened with 20 G cannula from the hand back (dorsum) which will operated and double-cuffed pneumatic tourniquet was inserted into the arm proximal. The arm was uplift for ten minutes and had veins drained by firmly wrapping the arm from finger tips towards shoulder to distal arm with the Esmarch bandage. First, the proximal cuff was inflated so as to be 150 mmHg more than systolic pressure. The distal cuff was lowered and the Esmarch bandage was removed. The 100 mg lidocaine+100 µg fentanyl from the IV cannula on the hand back which will be operated, was given in 40 ml and the distal cuff was inflated after 5 min then proximal cuff was put out. The sensory block was assessed and sensory block initial time and motor block initial time was recorded. The regression times of sensory and motor block were recorded. Also the complications during and after the operation were recorded. Duration of surgery was determined as 30.3±10.1 min and the duration of tourniquet was 41.3±9.1 min. Sensory block initial time was recorded as 8.1±2.6 min, and the time for sensory block regression was recorded as 6.2±3.1 min. The motor block initial time was recorded as 13.4±5.2 min and motor regression time was recorded as 5.6±2.8 min. The clinical diagnoses of the patients were shown in Table 2. According to the VAS scores, it was observed that adequate level of anesthesia and analgesia was maintained for all patients. The addition of low-dose lidocaine to fentanyl in IVRA may provide both sufficient and effective anesthesia and decrease the complications related with local anesthetic toxicity. Clinical article (J Int Dent Med Res 2013; 6: (2), pp. 96-99)

Keywords

Low-Dose Lidocaine, Rejyonal Intravenoz Anesthesia, Upper Extremity.

References

Hilgenhurst G. The Bier block after 80 years: a historical review. Reg Anesth 1990; 15: 2-5.
Chilvers CR, Kinahan A, Vaghadia H, et al. Pharmacoeconomics of intravenous regional anaesthesia vs general anaesthesia for outpatient hand surgery. Can J Anaesth 1997; 44: 1152-56.
Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth 2002; 49: 32-45.
Memis D, Turan A, Karamanlioglu B, et al. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004; 98: 835-40.
Lurie SD, Reuben SS, Gibson CS, et al. Effect of clonidine on upper extremity tourniquet pain in healthy volunteers. Reg Anesth Pain Med 2000; 25: 502-05.
Sakirgil E, Gunes Y, Ozbek H, et al. [Comparison of ropivacaine, ropivacaine plus tramadol and ropivacaine plus morphine in patients undergoing minor hand surgery]. Agri 2005; 17: 52-8. Turan A, Karamanlıoglu B, Memis D, Kaya G, Pamukçu Z. Intravenous regional anesthesia using prilocaine and neostigmine. Anesth Analg 2002; 95: 1419-22.
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.
Kleinschmidt S, Stöckl W, Wilhelm W, Larsen R. The addition of clonidine to prilocaine for intraveneous regional anaesthesia. Eur J Anaesthesiol 1997; 14: 40-6.
Turan A, Memis D, Karaman lıoglu B, Güler T, Pamukçu Z. Intravenous regional anesthesia using lidocaine and magnesium. Anesth Analg 2005; 100: 1189-92.
Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications. J Clin Anesth 2009; 21: 585-94.
Sen S, Ugur B, N.Aydın O, Ogurlu M, Gursoy F, Savk O. The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia. Anesth Analg 2006; 102: 916-20.
Ivie CS, Viscomi CM, Adams DC, Friend AF, Murphy TR, Parker C. Clonidine as an adjunct to intravenous regional anesthesia: A randomized, double-blind, placebo-controlled dose ranging study. J Anaesthesiol Clin Pharmacol 2011; 27: 323-7.