الفهرس 
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Abstract
Intravenous regional anesthesia (IVRA) was first described by August
Bier in 1908. He observed that when local anesthetic was injected
intravenously between two tourniquets on a limb, a rapid onset of
anesthesia occurred in the area between the tourniquets and a slower
onset occurred beyond the distal tourniquet. However, the technique
did not become popular until the 1960s, when it was reintroduced by
Holmes.
Our study compares Lidocaine alone in IVRA as a control group,
versus lidocaine with the addition of transdermal nitroglycerine ,
lidocaine with the addition of neostigmine and lidocaine with addition
of combination of transdermal nitroglycerine and neostigmine.
Eighty patients were divided into four equal groups as follow:
Group 1: Neostigmine group :A dose of 2.5 mg/kg lidocaine 0.5%
(0.5 ml/kg) with addition of 0.5 of neostigmine. [n=20]
Group 2: Transdermal nitroglycerine group: A dose of 2.5 mg/kg
lidocaine 0.5% (0.5 ml/kg) with addition of 5 mg transdermal
nitroglycerine(nitroglycerine patch is applied 2 hours before the start
of IVRA). [n=20]
Group 3: Neostigmine -transdermal nitroglycerine group: A dose of
2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with addition of 5 mg
transdermal nitroglycerine (nitroglycerine patch is applied 2 hours
before the start of IVRA) and 0.5 mg neostigmine. [n=20]
Group 4: Lidocaine only : with dose 2.5 mg/kg lidocaine 0.5% (0.5
ml/kg) [n=20]
The solution was given by anesthetist who doesn’t know the content
of the syringe over 3 minutes.
Our assessment was performed depending upon the following 1- Motor and sensory block onset:
2- The mean arterial blood pressure (MAP), heart rate (HR), and
oxygen saturation ( SPO2)
3- The assessment of tourniquet and incision-related pain
4- Onset of tourniquet pain:
5- Number of patients complaining of tourniquet pain
6- Analgesic requirement during intraoperative – and 24 hours during
the postoperative period
7- Recovery time
8- Duration of effectiveness of analgesic effect of IVRA in minutes
9- Patient satisfaction
10- Surgeon opinion
11- Complications
At the end of the study, tourniquet was released by cyclic deflation
method to avoid ischemic reperfusion injury and sudden wash out of
local anesthetics into systemic circulation.
from the study the characters of the resulting analgesia in the four
groups were as the following:
Neostigmine group showed significant decrease in sensory and motor
block onset times and delay of sensory and motor recovery times. This
group also showed decreased intra- and post-operative VAS and
delayed onset of tourniquet pain , amount of needed analgesia intraand
post- operatively was also less than control lidocaine group.
Transdermal nitroglycerine group showed significant decrease in
sensory and motor block onset times and longer of sensory and motor
recovery times. This group also showed decreased intra- and postoperative
VAS and delayed onset of tourniquet pain , amount of needed analgesia intra- and post- operatively was also less than
control lidocaine group but less than neostigmine group and
combination group.
Neostigmine and transdermal nitroglycerine group showed highly
significant decrease in sensory and motor block onset times and delay
of sensory and motor recovery times. This group also showed
decreased intra- and post-operative VAS and delayed onset of
tourniquet pain , amount of needed analgesia intra- and postoperatively
was also less than control lidocaine group and both of
neostigmine group and transdermal nitroglycerine group.
from this study we conclude the following; Adding 0.5 mg
neostigmine as an adjuvant to lidocaine for IVRA improved the speed
of onset and the quality of anesthesia, decreased tourniquet pain and
intraoperative and postoperative analgesic consumption, and caused
no side effects.
Adding 5 mg transdermal nitroglycerine as an adjuvant to lidocaine
for IVRA caused prolongation in sensory and motor recovery times
,decreased VAS scores and analgesic consumption intra and
postoperatively so it improved the quality of the produced regional
anesthesia but not as neostigmine or combination of neostigmine and
transdermal nitroglycerine and also no side effects were encountered.
Adding neostigmine and 5 mg transdermal nitroglycerine as an
adjuvant to lidocaine for IVRA caused prolongation in sensory and
motor recovery times ,decreased VAS scores and analgesic
consumption intra and postoperative so it improved the quality of the
produced regional anesthesia more than neostigmine or transdermal
nitroglycerine alone and also no side effects were encountered.