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Abstract
Intravenous regional anaesthesia (IVRA) has grown in popularity as a simple technique that can be easily administered. It is a valuable technique for surgical procedures on the limb, being well tolerated, avoiding the risks of general anaesthesia. However, there are concerns with regard to it, which include local anaesthetic toxicity, delayed onset of action, poor muscle relaxation, and rapid onset of pain at the operative site after the tourniquet has been deflated .There have been attempts to overcome these problems by addition of various drugs to the local anaesthetic agents. The most important of them are muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate pain associated with tourniquet inflation and post-operative pain.
The aim of the present study was to assess the potency and efficacy of adding cisatracurium to lignocaine in IVRA regarding the onset and recovery times of nerve block, the tourniquet pain and intra and postoperative analgesia.
The present work was performed on forty adult patients scheduled for hand and forearm surgery after taking informed consent to participate in this study.The study was approved by Medical Research Institute. Excluded patients were those of peripheral vascular disease, peripheral neuropathy, major psychiatric disorders, sickle cell anemia or with known drug allergy. After application of routine monitors, patients were classified into two groups; (20) patients each. Patients of group I received 3mg/kg lignocaine 2%; diluted with saline to a total volume of 40 ml , injected locally intravenous in the targeted upper limb. Patients of group II received 0.01mg/kg cisatracurium added to 3mg/kg lignocaine 2%; diluted with saline to a total volume of 40 ml, injected locally intravenous in the targeted upper limb.
Vital signs (mean arterial blood pressure, heart rate and oxygen saturation) were recorded to all patients preoperatively(base line), immediately(0 min), 5, 10, 20 and 30 min from tourniquet inflation and immediately(0 min),15, 30, 120, 360 and 720 min after tourniquet deflation. Also, the sensory and motor block and recovery times were be assessed by pinprick test at all dermatomal distribution below proximal cuff. The tourniquet pain was assessed regarding the onset time and its severity. In the present study, the intraoperative requirements of fentanyl as regard the first time and total dose of required analgesia were assessed. Also,the post operative analgesia was evaluated by : Post operative pain onset time, severity of the post operative pain by (VAS) at 0, 30, 120, 360 and 720 min, after tourniquet deflation, the total dose of required analgesia and the time of first analgesic requirement were recorded. Evaluation of surgeon’s satisfaction and reported side effects were notified .