Clonidine Versus Ketamine to Prevent Tourniquet Pain During Intravenous Regional Anesthesia With Lidocaine

Gorgias, N.; Maidatsi, P.; Kyriakidis, Anastasios M.; Karakoulas, K.; Alvanos, Demetrios N.; Giala, M.

doi:10.1097/00115550-200111000-00005

Cited by 36 publications

(9 citation statements)

References 22 publications

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“…Motor block recovery time (time from tourniquet deflation to the time patient can move his fingers) was also recorded. Verbal Rating Scale scores at rest were assessed at 2, 4, 6,8,10,12,14,16,18,20,22, and 24 hours postoperatively. A rescue analgesia of diclofenac 75 mg intramuscularly was given if requested or if pain scores were 2 or greater.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia

Abdel‐Ghaffar

Kalefa

Imbaby

2014

Regional Anesthesia and Pain Medicine

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Section: Methodsmentioning

confidence: 99%

Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia

Abdel‐Ghaffar

Kalefa

Imbaby

2014

Regional Anesthesia and Pain Medicine

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“…Various adjuncts (eg, opioid, nonsteroidal anti-inflammatory drugs, clonidine, dexmedetomidine, ketorolac, dexamethasone, muscle relaxants, neostigmine, ketamine and magnesium) have been tried to hasten the onset, maintain adequate muscle relaxation, reduce tourniquet pain, and increase the duration of analgesia [9], and to reduce the dose of anesthetic drugs to reduce the toxicity [10]. Ketamine is a well-known analgesic drug that acts at least in part as an N-methyl-D-aspartate acid (NMDA) antagonist [11].…”

Section: Introductionmentioning

confidence: 99%

Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain

Yaghubi¹,

Rashtchi²,

Karamitanha³

2016

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Background and purpose:The main and the most known complication of intravenous regional anesthesia (IVRA) is systemic toxicity due to local anesthetics that occurs following the accidental tourniquet release immediately after injection. This study aims to evaluate the effect of adding ketamine to lower dose of lidocaine on reducing the dose and side effects of lidocaine. Materials and Methods: In this randomized clinical trial, 60 patients undergoing the surgery of upper limb below the elbow under IVRA were randomly divided into two groups. In group 1 (control group), 40 ml lidocaine 0.5% (200 mg) and in group 2 (intervention group), 40 ml lidocaine 0.25% (100 mg) plus 40 mg of ketamine 0.1% injected intravenously. Outcomes included postoperative pain at 15, 30 and 60 minutes after surgery. The pain of the patients was assessed by using the Visual Analogue Scale (VAS Score). Results: Both groups were comparable in demographic and surgical parameters. The average pain based on the VAS score at 15, 30 and 60 minutes after surgery was similar in both groups and there was no significant difference between the two groups (p> 0.05). Moreover, postoperative complications including unconsciousness, restlessness, dizziness, nausea, vomiting, tinnitus, seizure, delirium and hallucination had no significant differences (p> 0.05). Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects.

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“…The increase in blood pressure is resistant to analgesics and/ or an increase in the depth of anaesthesia 5,6 . The mechanisms involved in tourniquet pain are not well understood but have been postulated to be conducted by A-delta and C-fibres which are thought to mediate somatic pain 3,[8][9][10] .…”

mentioning

confidence: 99%

“…The treatment is non-specific, and various methods have been used to counter the effects of tourniquet pain, these include intravenous bolus doses, local application, local anaesthesia, per oral administration, sub-cutaneous injection and regional anaesthesia, but most have been found to be unsatisfactory 10,11,12 . Several studies have been carried out to investigate the most effective agent in attenuating tourniquet induced hypertension and ketamine has been found to be one of the most effective intravenous agent through its interaction with the N-methyl D-aspartate receptor 8,10,13 .…”

mentioning

confidence: 99%

“…Several studies have been carried out to investigate the most effective agent in attenuating tourniquet induced hypertension and ketamine has been found to be one of the most effective intravenous agent through its interaction with the N-methyl D-aspartate receptor 8,10,13 . Ketamine use for tourniquet pain⁄ hypertension has been widely investigated 8,10,13,16 . A study done by JW Park et al using 0.1mg⁄kg I.V and placebo on tourniquet induced hypertension during 60 minutes of tourniquet inflation concluded that low dose ketamine given pre-operatively prevented tourniquet hypertension and no patients were found to have ketamine induced psychomimetic effects during follow-up at 1 hour and 24 hours after waking.…”

mentioning

confidence: 99%

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A randomized controlled trial to assess the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing upper and lower limb surgery

Ongaya¹,

Mung’ayi²,

Sharif³

et al. 2017

Afr H. Sci.

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Background: Tourniquet hypertension arising from tourniquet inflation remains a primary concern to the anaesthetist. One drug commonly used to manage tourniquet hypertension is ketamine. No studies have examined the effect of ketamine on tourniquet hypertension for a period of more than one hour or an infusion of the same. Objective: To compare the effect of an intravenous infusion of ketamine versus placebo on tourniquet induced hypertension in patients undergoing upper and lower limb surgery under general anaesthesia. Methods: Forty six adult patients scheduled for upper and lower limb surgery under general anaesthesia were randomized into two equal groups. The ketamine group received an intravenous bolus of 0.1mg/kg of ketamine followed by an infusion of 2ug/kg/min. The saline group received an intravenous bolus of physiological saline followed by an infusion of saline. All the patients were reviewed post-operatively. Data of the baseline characteristics, haemodynamic changes, post-tourniquet pain and side effects were collected. If post-tourniquet pain was present post-operatively, a visual analogue scale (VAS) was used to assess its severity. Results: 46 patients successfully completed the trial. There were no significant differences between the groups for baseline patient demographics. The incidence of tourniquet hypertension was higher in the saline group (26.1%) compared with ketamine group (4.6%) with a 95% confidence interval. The difference was shown to be statistically significant ('P'<0.05). There was an increase in systolic blood pressure after 60 minutes of tourniquet inflation in the saline group but the difference was not statistically significant('P'>0.866). There were no significant differences between the groups as regards diastolic blood pressure and heart rate. VAS scores did not differ between the two groups. Statistically, there was no difference found between the two groups. Side effects were minimal in the ketamine group whilst in the saline group, nausea and vomiting were predominant but were also not statistically significant. Conclusion: Based on the results of this study,there was a difference in the proportion of tourniquet hypertension between the ketamine and saline groups for patients undergoing upper and lower limb orthopaedic surgery under general anaesthesia. Keywords: Randomized controlled trial, effect of a ketamine infusion, tourniquet hypertension, general anaesthesia, upper and lower limb surgery.

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Clonidine Versus Ketamine to Prevent Tourniquet Pain During Intravenous Regional Anesthesia With Lidocaine

Cited by 36 publications

References 22 publications

Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia

Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia

Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain

A randomized controlled trial to assess the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing upper and lower limb surgery

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