Study of post-operative analgesia after addition of opioids with intravenous regional anesthesia
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 9, Issue 3
Abstract
Background: Intravenous regional anesthesia was first discovered by August Carl Gustav Bier. In 1908 came the first Bier’s paper in “Venous Anesthesia” which was natural outgrowth of his previous work with tourniquet and anesthesia methodology. The technique gained considerable popularity for a time, as evidenced by the flood of articles which appeared. These were all short, case report type studies confirming the feasibility of Bier’s method. Aims and Objective: To study the post-operative analgesia after intravenous Regional Anaesthesia by using 0.25% lignocaine with fentanyl and pancuronium bromide. Material and Methods: For the purpose of study two groups were formed containing 25 patients each. Group A: Patients received intravenous regional anesthesia with standard method i.e. 3 mg/kg of 0.5% lignocaine. Group B: Patients received intravenous regional anesthesia with 1.5mg/kg of 0.25% lignocaine + Pancuronium 0.5 mg + fentanyl 1 ug/kg. The details of all the patients were entered on a standard proforma. Standard protocol was used for inducing the regional anesthesia. The limb to be operated was kept elevated above the level of the heart for 2 to 4 minutes for gravity drainage. Esmarch’s bandage was applied to ensure complete exxsanguination. Both the methods were used for all patients. After exsanguinations, the tourniquet was applied to occlude the vessels by first wrapping the side where the tourniquet was to be applied with cotton roll to reduce the tourniquet discomfort. Then group A patients received Lignocaine 0.5%, 3 mg/kg and group B received, Lignocaine 0.25%, 1.5mg/kg+fetanyl 1 ug/kg+ pancuronium 0.5mg. The drug was injected, the skin usually became mottled and analgesia developed rapidly. The muscle relaxation was profound. As the drug was injected, the forearm was tested for analgesia (loss of sensation for pin prick was elicited). The time of onset of sensory block and motor block was noted. The quality of anesthesia developed was also measured. Results: Majority of cases were male in both the groups. The age group in majority of patients undergone surgery were in the age group of 20-30 years. In group A, 20 patients had excellent block, 3 had good quality block and 2 had moderate quality block. Whereas in group B 19 patients had excellent block, 4 had good quality block and 2 had moderate quality block. In group A patients post operative analgesia in 48% of patients remained for 25 to 34 minutes. In 20% cases it remained for 15 to 24 minutes and in 32% of cases it remained for 35 to 44 minutes. In group B patients 12% of the patient had post operative analgesia for 15 to 24 minutes and in 48% cases analgesia remained for 25 to 34 minutes and in 8% cases the post operative analgesia remained for 45 to 54 minutes. And the difference observed was not statically significant. In group A patients one patient had bradycardia and one of the patient had hypotension and other patient had no complication after the release of tourniquet. In group B patient only one patient had giddiness after the release of tourniquet. Conclusion: Thus we conclude that the quality of analgesia and duration of post operative anesthesia was almost same in both the groups. But the rate of complication was reduced due less dose of lignocaine in group B.
Authors and Affiliations
Bhagwan Marotirao Patil, P K Jadhav
Keywords
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- EP ID EP521153
- DOI 10.26611/1015933
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