Comparative Evaluation of Efficacy of Plain Lignocaine 0.5%(3mg/ kg) with Lignocaine 0.5%(3mg/kg) + Buprenorphine (3μg/kg) in IV Regional Anaesthesia

Abstract

Introduction:The main objective of the anaesthesiologist is to provide analgesia for surgery. Even though general anaesthesia was the earliest technique adopted to provide analgesia for surgery, the search for an alternative was made in order to overcome the problems and complications related to situations like `full stomach', in emergency surgeries. This Study aimed to evaluate the usefulness of adding an opioid analgesic, Buprenorphine 3μg/kg to 0.5% xylocaine 3 mg/kg (0.6 ml/ kg) in intravenous regional anaesthesia (Holmes' modification of Bier's Block) for forearm and hand surgeries in providing postoperative analgesia without increased incidence of side effects and complications. Material and methods: This clinical study was conducted for a period of 2 years (2002 -2003) at SV Medical college, SVRRGGH, Tirupati. 50 patients of ASA Grade -I and II of either sex undergoing upper limb (forearm and hand) surgery under intravenous regional anaesthesia, were randomly assigned to one of the 2 groups (25 each). Patients in Group -A received IVRA with Lignocaine 0.5% 3 mg/kg (0.6 ml/kg) and those in Group -B received IVRA with Lignocaine 0.5% 3 mg/kg (0.6 ml/kg) and 3μg/kg Buprenorphine. Onset and recovery times of sensory blockade (as assessed by pinprick), onset and recovery times of motor blockade (as assessed by flexion and extension movements of wrist and fingers and hand grip), postoperative duration of analgesia (as assessed by numerical pain rating scale score) and tourniquet times were compared between the two groups by t -test. The incidence of complications (respiratory depression, nausea, vomiting etc.,) were also compared between the two groups by chi -square test . Results:The mean onset time (i.e., injection to analgesia time) of sensory blockade (analgesia) in Buprenorphine + Lignocaine group (Group-B) was considerably less (3.72 ± 1.48 minutes) compared to that in Lignocaine group (Group-A) (6.24 ± 1.94 minutes) and the difference was also statistically significant (t = 5.26; p<0.001). Postoperative duration of analgesia in Buprenorphine + Lignocaine group (Group-B) was considerably more prolonged (447.4 ± 57.9 minutes) compared to that in Lignocaine group (8.92 ± 2.69 minutes) and the difference was statistically significant (t= 37.83; p<0.001). The recovery time of sensory blockade and the onset and recovery times of motor blockade and the tourniquet times were comparable between the two groups and yielded no statistical significance. Amongst all the complications compared between the two groups in the post operative period , only the incidence of vomiting in Group-B (12 cases) was statistically significant (χ2 = 8.03; df = 1; p<0.01, s) .Conclusion: Intravenous regional anaesthesia with addition of Buprenorphine to Lignocaine results in early onset of analgesia, prolonged residual (postoperative) analgesia and is free from any significant side effects. , T Jamuna. Comparative evaluation of efficacy of plain lignocaine 0.5%(3mg/kg) with lignocaine 0.5%(3mg/kg) + buprenorphine (3µg/kg) in IV region...