The Addition of Low-dose Mivacurium to Lidocaine for Intravenous Regional Anesthesia

Abstract

Objectives: The current study aimed to evaluate low dosage of mivacurium added to lidocaine for intravenous regional anesthesia [IVRA].Methods: The present study used a double-blind methodology. The study group comprised 60 patients with the American Society of Anesthesiologists physical status I and II, who were scheduled to undergo carpal tunnel release as an outpatient procedure. Patients were randomly divided into two groups. In the mivacurium group [Group M; N = 30], intravenous regional anesthesia was achieved using 6 mg of mivacurium with lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml; in the control group [Group C; N = 30] 3 mg/kg lidocaine was diluted with saline to a total volume of 40 ml. The onset and recovery time of sensory and motor blocks, intraoperative-postoperative visual analog scale, and verbal rating scale, tourniquet pain, satisfaction score, analgesic requirement, hemodynamic variables, and side effects were noted.Results: Group M showed significantly shorter sensory block and motor block onset time, longer motor block recovery time, and decreased analgesic requirement during the 24-hour postoperative period.Conclusions: Despite the longer motor block recovery, the addition of a low dose of mivacurium to lidocaine for IVRA accelerated the sensory and motor blocks onset and improved the postoperative analgesia without important perioperative adverse effects. We demonstrated that the addition of a low dose of mivacurium to lidocaine for IVRA provided a significant clinical benefit by shortening the sensory and motor blocks onset, providing sufficient muscle relaxation, and also reducing postoperative analgesic consumption without any serious adverse effects.

Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts

“…Mizrak et al50 found similar results to the previous studies, demonstrating a faster onset of sensory block by adding mivacurium (0.6 mg) to plain lidocaine (3.1 ± 0.5 minutes vs 2.2 ± 0.8 minutes). No study identified a difference in sensory recovery compared to control 6,50…”

“…The muscle relaxants investigated were pancuronium,33,38,44 atracurium,49,51,52 mivacurium,41,50,53 and cisatracurium 6…”

“…Two studies evaluating muscle relaxants as sole adjuncts to LA found a faster onset of motor block 6,50. With the addition of mivacurium (0.6 mg) to lidocaine (3 mg · kg −1 ), Mizrak et al50 found a faster onset of motor block by approximately 2 minutes.…”

“…Three studies did not report a faster onset of block, yet described a significantly greater degree of muscle relaxation with the addition of 0.5 mg pancuronium33 or 2 mg atracurium33,49,52 to IVRA. Five out of six studies evaluating the recovery of motor block found it to be significantly prolonged in patients receiving muscle relaxant 6,49,50,52,53…”

“…Two studies investigating tourniquet pain found no improvement with the addition of muscle relaxant to LA 50,51. Elhakim and Sadek49 described significantly improved intraoperative VAS scores unrelated to the tourniquet site.…”