Comparison of Efficacy of Plain Lignocaine With Lignocaine and Clonidine in Intravenous Regional Anaesthesia for Upper Limb Surgery

Abstract

INTRODUCTION: IVRA is a simple, reliable, and effective technique with rapid onset of action, rapid and prompt recovery after tourniquet release. It provides good analgesia, adequate muscle relaxation, & bloodless operative field. It is widely applicable to patients of different ages and physical status for operations & cost effective. Lignocaine though preferred local anesthetic agent has limitation of short duration of anesthesia & inability to provide postoperative analgesia various additives were added to it. In this study we compared efficacy of clonidine as an adjuvant to lignocaine with plain Lignocaine. MATERIAL & METHOD: Patients undergoing upper arm surgery were included in this study & are divided in two groups. The proximal circulatory isolation of arm was done by placing a pneumatic tourniquet around arm. In group C IVRA was given by 1ug/kg clonidine & 0.5% preservative free lignocaine in a dose of 200mg diluted up to 40 ml & in group L 0.5% preservative free lignocaine 200 mg diluted up to 40 ml. Tourniquet was deflated at least 30 mines after injection of drug. AIMS & OBJECTIVES: To compare onset and quality of sensory analgesia, Onset and quality of motor blockade, onset & severity of tourniquet pain, Complications like hypotension &bradycardia during the procedure, recovery from sensory and motor blockade duration of Postoperative analgesia in group C with group L. CONCLUSION: We observed that using Clonidine in dose of 1 ug/kg as an adjuvant to Lignocaine in IVRA does not have early onset of sensory blockade, increased tourniquet tolerance, delayed tourniquet pain and extended post-operative analgesia .Neither systemic side effects like nausea, bradycardia, hypotension, convulsion nor local complications like hematoma were observed. INTRODUCTION: Intravenous regional anaesthesia was originally introduced by the German surgeon August K. G. Bier 1 in 1908; thus the name, "Bier block". Dr. Bier described a complete anaesthesia and motor paralysis after intravenous injection of Prilocaine into a previously exsanguinated limb. It is a simple, reliable, and effective technique with rapid onset of action, and prompt recovery after tourniquet release. It provides good analgesia, adequate muscle relaxation, & bloodless operative field, widely applicable to patients of different ages and physical status for operations & cost effective. Poor postoperative analgesia, limited duration of anaesthesia (<90 minutes), the potential for local anesthetic toxicity, nerve damage and compartment syndrome are the disadvantages of intravenous regional anaesthesia.