Intravenous regional anesthesia using lidocaine and neostigmine for upper limb surgery

Sethi, Divya; Wason, Rama

doi:10.1016/j.jclinane.2009.09.005

Cited by 13 publications

(5 citation statements)

References 34 publications

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“…When higher concentrations of neostigmine (2–4 μg.kg ‐1 ) were employed, analgesia was prolonged for 11 h without increasing the incidence of adverse effects [144]. In patients undergoing intravenous regional anaesthesia for upper limb surgery, those who received lidocaine with neostigmine experienced prolonged postoperative anaesthesia and shorter sensory and motor onset times compared with its adjunct‐free counterpart [145]. Understanding of neostigmine as an adjunct for peripheral block is incomplete.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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Summary Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long‐ and short‐acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non‐steroidal anti‐inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non‐steroidal anti‐inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose‐dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.

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Section: Resultsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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“…[3][4][5][6] Numerous attempts to reduce the severity of tourniquet discomfort, improve the quality of block and to prolong postoperative analgesia have been made by adding a wide range of adjuvant drugs (apart from opioids) like ketorolac, clonidine, dexmedetomidine, magnesium, ketamine, paracetamol and neostigmine to the local anaesthetic (lidocaine) in IVRA. [19][20][21][22][23][24][25] Tourniquet pain was not the major concern in our study probably as a result of using double-cuff tourniquet technique (Holmes' modification). Tsai YC et al, compared EMLA cream, subcutaneous ring anesthesia and double cuff technique in the prevention of tourniquet pain and concluded double cuff technique to be most effective.…”

Section: Discussionmentioning

confidence: 65%

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

Kumar¹,

Babu²,

Prasad³

et al. 2018

IJCMR

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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...

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“…Lidocaine is an adjunctive analgesic, widely used in nerve block and intravenous infusion due to its analgesic, anti-arrhythmic, anti-inflammatory effects, or anti-cancer mediated by a number of molecular mechanisms [37][38][39][40] . Intravenous lidocaine has the added advantage of alleviating surgical inflammation, and immune alterations and sparing opioids 21,41 . Systemic administration of lidocaine could alleviate streptozotocininduced allodynia, supposedly by modulating the p38 pathway in spinal microglia 42 .…”

Section: Discussionmentioning

confidence: 99%

Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial

Wu,

Chen,

Yao

et al. 2023

Sci Rep

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Surgery is one of the most frequent and effective intervention strategies for lumbar spinal stenosis, however, one-third of patients are not satisfied with postoperative outcomes. It is not clear whether perioperative systemic lidocaine could accelerate the early postoperative quality of recovery in patients undergoing lumbar spinal stenosis surgery. 66 patients were enrolled in this trial. Lidocaine or placebo was administered at a loading dose of 1.5 mg/kg for 10 min and then infused at 2.0 mg/kg/hour till the end of surgery. Continued infusion by postoperative patient-controlled intravenous analgesia with a dose of 40 mg/hour. The primary outcome was the quality of recovery. Secondary outcomes included the time of the patient's first flatus, catheter removal time, underground time from the end of the surgery, pain score, levels of inflammatory factors (IL-6, IL-10, TNF-α), postoperative nausea and vomiting (PONV), sufentanil rescues, patients’ satisfaction scores, and complications of lidocaine. Eventually, 56 patients were in the final analysis with similar age, Body Mass Index (BMI), duration of surgery and anesthesia, and median QoR-15 score (a development and Psychometric Evaluation of a Postoperative Quality of Recovery Score). The difference in median QoR-15 score in placebo versus lidocaine patients was statistically significant (IQR, 106 (104–108) versus 114 (108.25–119.25), P < 0.001). The Numeric Rating Scale (NRS) score at the 12th hour, median sufentanil rescue consumption, IL-6, tumor necrosis factor-alpha (TNF-α) of patients treatment with lidocaine were lower. Nevertheless, patients given lidocaine had high satisfaction scores. Suggesting that lidocaine enhanced the postoperative quality of recovery, met early postoperative gastrointestinal function recovery, provided superior pain relief, lessened inflammatory cytokines, etc., indicating it may be a useful intervention to aid recovery following lumbar spinal stenosis surgery.

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Intravenous regional anesthesia using lidocaine and neostigmine for upper limb surgery

Cited by 13 publications

References 34 publications

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

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

Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial

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