Title: Comparative Evaluation of Lignocaine 0.5% and Lignocaine 0.5% with Pethidine for Intravenous Regional Anaesthesia in Upper Limb Surgery
Authors: Dr C M Priyamani, Dr Sreekala Devi K
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.84
Abstract
Introduction: Intravenous regional anesthesia is particularly useful in the surgery of the extremities, especially in cases with full stomach and as an outpatient technique in orthopedic procedures. The low failure rate, requirement of minimal equipment, minimal hospital stay and expenditure makes IVRA an ideal technique in the hospital setup of a developing country. Several studies using different drugs and their combination have been experimented with. This is to overcome certain limitations of the study like lack of postoperative analgesia and occasional toxic reactions to the drugs used. Among narcotics morphine, fentanyl and pethidine have been used by various researchers as adjuvants. Among these pethidine is known to have peripheral local anesthetic action. Study was undertaken with view to promote IVRA as a safe and cost effective method of anesthesia for extremity procedures, to assess the advantage of adding pethidine to the local anesthetic for IVRA and to assess the incidence of side effects and complications if any related to the above procedure.
Materials and Methods: A randomized double blinded study was conducted in which 40 patients were included who were randomly allocated to 2 groups of 20 each to receive either lignocaine alone (Group 1-control group) or lignocaine with pethidine (Group 2- study group) for IVRA. Patients between the ages of 18-50 years scheduled for upper limb surgery were selected.
Inclusion Criteria: Only ASA grade 1 and 2 patients were included.
Exclusion Criteria: those patients who had high level of anxiety, who had history of allergic response to any drug, hemolytic disease, vascular or neurologic diseases, bleeding disorders, hypertension and diabetes mellites were excluded.
The grading of analgesia was classified as Grade 1(Excellent-complete loss of sensation to touch, position, pin prick, deep pressure and total paralysis of muscle). Grade 2( Good- mild discomfort but tolerable to patient, deep pressure sensitive, muscle paralysis less than total i.e. Appearing late in procedure). Grade 3( Fair- more discomfort requiring supplements). Grade 4( Poor- requiring conversion to GA for completion of procedure). Tourniquet pain was recorded as present or absent.
The collected data were analyzed using SPSS software. For comparing the differences between the study group and control group student t test was applied. The association between variables were assessed using Chi squire test. A p value of <0.05 was considered statistically significant.
Results: The results show that the onset of analgesia was three times quicker in group 2 patients compared to Group 1. Patients in Group 2 had significantly higher quality of anesthesia than Group 1 patients. Patients in Group 2 also had significantly better postoperative analgesia in comparison with Group 1.
Conclusion: The addition of pethidine to lignocaine for IVRA significantly improves the quality of block, provides a faster onset of action and prolongs postoperative analgesia effectively.
