A New Approach to Intravenous Regional Anesthesia

Abstract

In an attempt to reduce the dose of local anesthetic during intravenous (IV) regional anesthesia of the upper limb, we combined 100 mg of lidocaine with 0.05 mg of fentanyl and 0.5 mg of pancuronium. The study was designed in a randomized, double-blind fashion to determine the efficacy of this approach in providing analgesia and relaxation during surgery and to evaluate its safety after immediate deflation of the tourniquet following IV drug injection. Eighty unpremedicated patients, ASA physical status I or II, were assigned to the following groups: group A (n = 15) received 100 mg of lidocaine diluted in 40 mL of NaCl IV; groups B-D (n = 15 in each group) received 100 mg of lidocaine diluted in NaCl, with the addition of 0.05 mg of fentanyl (group B) or 0.5 mg of pancuronium (group C), or both (group D) to a total volume in all groups of 40 mL. Patients in groups A-D underwent elective operations on the forearm, wrist, and hand; for evaluation of safety, in 20 volunteers (group E) the tourniquet was immediately released after IV injection of the three drugs at the previously described doses. The analgesic effect was more profound in group D compared with groups A-C. In group D, 9 of 15 patients had excellent analgesia. In six patients, pain was experienced at the beginning of surgery, but 5 min thereafter patients remained pain free.(ABSTRACT TRUNCATED AT 250 WORDS)

A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures

“…Two of these studies looked at the use of two adjuncts in combination with LA, 6 , 7 and one study compared four separate adjuncts to control. 8 Ten studies investigated opioids [6][7][8][9][10][11][12][13][14][15] and one tramadol 1 6 (Table I). Six studies investigated non-steroidal antiinflammatory drugs (NSAIDs) 8,[17][18][19][20][21] and five clonidine 8,[22][23][24][25] (Table II).…”

“…Six studies investigated non-steroidal antiinflammatory drugs (NSAIDs) 8,[17][18][19][20][21] and five clonidine 8,[22][23][24][25] (Table II). Five studies investigated muscle relaxants, 6,7,[26][27][28] three alkalization, [29][30][31] one potassium 3 2 and two temperature 33,34 (Table III). None of the studies reported sample size estimation and power analysis.…”

“…Ten studies involving 412 patients have investigated opioids either as sole adjunct [8][9][10][11][12][13][14][15] or in combination with a muscle relaxant 6,7 (Table I). One of the combination studies also included fentanyl as a sole adjunct.…”

“…No study included a systemic control group. Six out of ten studies were supportive of the addition of the adjunct(s) [6][7][8][13][14][15] (two with fentanyl plus pancuronium, 6,7 two with meperidine, 13,15 one with morphine 1 4 and one with sufentanil). 8 FENTANYL Four studies on a total 157 subjects (including two volunteer studies), investigated fentanyl as sole adjunct.…”

“…8 FENTANYL Four studies on a total 157 subjects (including two volunteer studies), investigated fentanyl as sole adjunct. 6,[9][10][11] The dose range was 50-200 µg.…”