Comparison of Lidocaine V s Lidocaine + Ketorolac in Intravenous Regional Anaesthesia (Bier's Block)

Objective: To compare the duration of anaesthesia and degree of analgesia during intravenous regional anaesthesia using Lidocaine alone and Lidocaine with Ketorolac. Design: An international quasi experimental study. Place and duration: This study was carried out in Nishtar Hospital Multan from 01101/2006 to 3010612006 (6 Months). Results: Patients were divided into two groups A & B. In group A injection Lidocaine 0.5% 40ml was given whereas in group B injection Ketorolac 30mg was add to Lidocaine 0.5% 40ml. The degree of anaesthesia and duration of analgesia were compared in both groups. Haemodynamics were also recorded to see any systemic effects of drugs. Conclusion: We conclude that 30mg Ketorolac added to Lidocame in lYRA increases degree of anaesthesia and also provide prolonged postop analgesia.

Pain serves a biological function.It signals the presence of damage or disease within the body.In case of postoperative pain it is the resul of surgery.The effective relief of pain is of para importance to anyone treating patients undergoing gery'.This should be achieved for humanitarian re sons, but there is now evidence that pain relief rgnificant physiological benefits.Not only does e 'e pain relief mean a smoother postoperative course earlier discharge from hospital, but it may also re' -~• e incidence of chronic pain syndromes.
The relief of pain d ..:0 -gery is the main aim of -naesthesia.The choice of ~-relieving techniques may -: influenced by the SI e -gery.the degree of training and expertise of the -.
R~ref of surgical pain with minimal side e ects .e primary goal of any anaesthesia".The ~non of intravenous local anesthetic in an 1 olar by means of an ischemic cuff IS a simple and effe e hnique, with a low incidence of failure and high degree of safety.Intravenous regional anesthesia (lVRA first described in 1908 for anesthesia of the hand and forearm.The earliest agent injected into the isolated vascular space was procaine.The technique regained popularity in the 1960's when Holmes used lidocaine.Lido aine remains the standard local anesthetic (LA) agent for most of the surgical procedures.IVRA is simple to administer, reliable and cost-effective.'.It is ideal for short operative procedures on the extremities performed on an ambulatory basis.It is very safe provided excessive doses of local anesthetic are avoided, if the tourniquet' pressure IS carefully monitored and if resuscitation equipment is always immediately available.Disadvantages include concerns about LA toxicity, slow onset, poor muscle relaxation, tourniquet pain and minimal postoperative pain relief.The ideal IVRA solution should have the following features: rapid onset, safe dose of LA, reduced tourniquet pain and prolonged post deflation analgesia.At prese,nt, this may only be achieved by the addition of adjuncts to LA. Ketorolac is a useful adjuvant 94 ANNALS VOL. 13 NO.1 JAN -MAR 2007 to lidocaine for lYRA.This nonsteroidal antiinflammatory drug (NSAID) interferes with the synthesis of inflammatory mediators and can supplement postoperative pain relief.The development and refinement of regional anesthetic techniques for various types of surgery, mainly obstetric, ophthalmic and orthopedic surgery, and of continuous regional analgesia continues:'.We postulated that using the parenterally available NSAID Ketorolac (K) as a component of intravenous regional anesthesia (lYRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia.The aim of this study was to compare the duration of anaesthesia and the analgesic efficacy of Lidocaine alone and Lidocaine with Ketorolac during surgery with IVRA.

Material and methods
This was an interventional type quasi experimental study carried out in orthopedic theatre in Nishtar Hospital MuItan over a period of six months.It included 60 patients with ASA status I and II, scheduled for minor hand surgery and short orthopedic procedures of forearm who gave the formal written consent to participate in the study.Patients who had allergy to Lidocaine and Ketorolac, hepatic dysfunction, convulsive disorder and decompensated heart failure were excluded form the study.
Patients were randomly assigned to two groups, Group A received solution of 0.5% Lidocaine 40ml and Group B received 0.5% Lidocaine 40ml with Ketorolac (30mg).A double tourniquet was positioned on the upper operative arm.Routine monitors were applied before the drug was injected.Extremity was exsanguinated by elevating it and wrapping it with an esmarch bandage.Lidocaine (0.5%) or Lidocaine (0.5%) + Ketorolac 30mg, according to group assignment was injected IN.Sensory and motor loss was assessed at 1, 5, and 10 minutes interval till the complete block and time period noted in both groups.Intraoperative tourniquet pain was assessed at every 5 minute using a verbal analogue scale (VbAS).Patients were asked to quantify tourniquet pain by rating of discomfort between 0 (No Pain) and 10 (worst pain possible).
pa en a sessed their pain 30 and 60 minutes after tourniquet deflation using a 10 ern visual analogue scale (VA ).All patients were advised to take Naproxin Sodium --Omg when they feel pain.The time from tourniquet deflation to first dose of oral analgesic was noted.Demographic data and d analyzed using student t-test.\ 'b, -

Conclusion
We concluded that using the parenterally available SAID ketorolac (30mg) as a component of intravenous regionanesthesia (lYRA) suppress intraoperative tourniquet pi. and enhance postoperative analgesia and decrease the neei, for analgesic supplement during the first 24 hours.
<0.05).In addition group B required no analgesic supplement in recovery room post opera vely as compared to group A. Patients in group B had the longer period of the subjective comfort during which they ook no analgesia with the mean duration of anesthesia 5 --227 min when compared to the group A 213+ 88.65 rnin P <0.05).