Effectiveness of Low Dose Lidocaine With and Without Tramadol for Intravenous Regional Anesthesia: A Randomized Prospective Study
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- Category: Vol. 81, September 2013
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Effectiveness of Low Dose Lidocaine With and Without Tramadol for Intravenous Regional Anesthesia: A Randomized Prospective Study, ENAS M. SAMIR
Abstract
Background: Intravenous regional anesthesia (IVRA) is a simple, reliable and safe anesthesia technique suitable for short procedures of both upper and lower extremities. It does not, however, provide postoperative analgesia. Local anesthesia toxicity is a concern during IVRA. Several techniques have been devised to decrease the dose of lidocaine while improving postoperative pain, including the use of lidocaine with adju-vants such as opioids, alpha-2 agonists, and NSAIDs. The lowest concentration of lidocaine used in most reported studies is 0.5%.
Objective: To compare the efficacy of 0.4% lidocaine, alone, or with tramadol 100mg, with lidocaine 0.5% alone for IVRA.
Methods: This prospective randomized controlled study was carried out on 90 adult patients ASA I and II undergoing minor hand and forearm surgeries. Patients were randomized into three groups received IVRA: (Group A): Received 40mL Lidocaine 0.5%, (Group B): Received 40mL Lidocaine 0.4% and, (Group C): Received 40mL Lidocaine 0.4% + 100mg tramadol. Sensory block was tested by pinprick method. Visual analogue scale (VAS) was used to assess pain levels. Patients were also assessed for the time to the first analgesic request, the total 24h analgesic consumption, and side effects.
Results: Patient demographic and operative data were insignificantly different between groups. The incidence of tourniquet pain and the number of patients requiring GA were significantly higher in group B compared to the other 2 groups. Tramadol group (Group C), was significantly better compared to group A and B with respect to the time to the first analgesia. Patients in group C required less analgesia in 24h compared to the other 2 groups.
Conclusion: Lidocaine 0.4% with tramadol provides a superior analgesia than lidocaine 0.5% alone, and may decrease the risk of local anesthetic toxicity. Lidocaine 0.4% alone, did not provide reliable analgesia.