Atracurium with or without magnesium sulfate as an adjuvant to lidocaine for intravenous regional anesthesia in hand and forearm surgeries: A randomized controlled study

Mohamed Mohamed Abo Elenain; Mohamed Jamal Mohamed; Ezzat Mahmoud El Saudi; Mohamed Al-Saeed Abu Hatab

doi:10.53730/ijhs.v5nS2.12754

Authors

Mohamed Mohamed Abo Elenain
aboelenainmohamed@gmail.com
Anesthesia & Intensive Care Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Mohamed Jamal Mohamed Anesthesia & Intensive Care Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Ezzat Mahmoud El Saudi Anesthesia & Intensive Care Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Mohamed Al-Saeed Abu Hatab Anesthesia & Intensive Care Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt

Keywords:

Atracurium, Intravenous Regional Anesthesia, Magnesium Sulfate, hand and forearm surgerie

Abstract

Background: The use of adjuvant drugs in intravenous regional anesthesia [IVRA] for forearm and hand operations are used to elevate efficiency and quality of the block & decrease side effects. The optimal combination is achieved through ongoing experiments. Objective: To compare the outcome of Atracurium without or with Magnesium Sulfate added to lidocaine for intravenous regional anesthesia on analgesic efficacy after surgery throughout the 1^st twenty-four hours, beginning and periods of recovery of motor and sensory blockades, and intraoperative analgesia. Methods: 75 cases designated for hand or forearm operation have been randomly assigned to three groups. Group A underwent three milligrams per kilogram of two percent lidocaine. Group B underwent three milligrams per kilogram of two percent lidocaine and two milligrams of atracurium. Group C underwent three milligrams per kilogram of lidocaine two percent with two milligrams of atracurium and ten milligrams per kilogram of magnesium sulfate. Every preparation has been diluted with saline to achieve a total volume of forty milliliters. Analgesia after surgery throughout the 1^st twenty-four hours, the beginning and the periods of recovery of motor and sensory block, 1^st analgesic request, and side effects of the study medications have been evaluated.

Downloads

Download data is not yet available.

References

Prabhakar A, Lambert T, Kaye RJ, Gaignard SM, Ragusa J, Wheat S, et al. (2019): Adjuvants in clinical regional anesthesia practice: A comprehensive review. Best Pract Res Clin Anaesthesiol.; 33 [4]:415-423. doi: 10.1016/j.bpa.2019.06.001. DOI: https://doi.org/10.1016/j.bpa.2019.06.001

Farbood A, Khademi S, Tajvidi R, Hooshangi M, Salari S, Ghani M, Tahmasebi S, Jamali H. (2020): Comparison of Intravenous Regional Anesthesia with Single-Cuff Forearm Tourniquet and Hematoma Block and Traditional Method in Patients with Distal Radius Fractures; A Randomized Clinical Trial. Bull Emerg Trauma. 2020; 8[2]: 77-82. doi: 10.30476/ BEAT.46446.

Wedel, D.J. & Horlocker, T.T. (2008): Peripheral nerve blocks. In D.E. Longnecker et al (eds) Anesthesiology. New York: McGraw-Hill Medical.

Bansal A, Gupta S, Sood D, Kathuria S, Tewari A.(2011): Bier’s block using lignocaine and butorphanol. J Anaesthesiol Clin Pharmacol ; 27 [4]:4 65-9. doi: 10.4103/0970-9185.86580 . DOI: https://doi.org/10.4103/0970-9185.86580

5-Turan A, Karamanhoglu B, Memis D, Kaya G, Pamukçu Z. (2002): Intravenous regional anesthesia using prilocaine and neostigmine. Anesth Analg.; 95:1419–22. DOI: https://doi.org/10.1097/00000539-200211000-00058

Nolan , J.P & Baskett P. J. F. (1997): Analgesia and anesthesia". In David Skinner, Andrew Swain, Rodney Peyton & Colin Robertson. Cambridge Textbook of Accident and Emergency Medicine. Project co-ordinator, Fiona Whinster, Cambridge, UK: CambridgeUniversityPress.p. 194. ISBN 9780521 433 792.

Turan A, Memis D, Karamanlioglu B, Guler T, Pamukcu Z (2005). Intravenous regional anesthesia using lidocaine and magnesium. Anesth Analg; 100: 1189-1192. DOI: https://doi.org/10.1213/01.ANE.0000145062.39112.C5

Ozcan PE, Tugrul S, Senturk NM, Uludag E, Cakar N, Telci L,(2007). Role of magnesium sulfate in postoperative pain management for patients undergoing thoracotomy. J Cardiothorac Vasc Anesth ; 21:827–831. DOI: https://doi.org/10.1053/j.jvca.2006.11.013

Kurt N, Kurt I, Aygünes B, Oral H, Tulunay M.(2002). Effects of adding alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia. Eur J Anaesthesiol. 19(7):522-5. doi: 10.1017/s0265021502000856. PMID: 12113616. DOI: https://doi.org/10.1097/00003643-200207000-00010

Pooja B (2015) . Neha B., Jyoti D., and Bablesh M. A comparative evaluation of magnesium sulphate and nitroglycerineas potential adjuncts to lidocaine in intravenous regional anaesthesia. Int J Crit Illn Inj Sci. Jan-Mar; 5(1): 27–31.

Mirkheshti A, Aryani MR, Shojaei P, Dabbagh A.(2012). The effect of adding magnesium sulfate to lidocaine compared with paracetamol in prevention of acute pain in hand surgery patients under intravenous regional anesthesia (IVRA). Int J Prev Med ; 3:616–621.

Choyce A, Peng P(2002). A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth 2002; 49:32–45. DOI: https://doi.org/10.1007/BF03020416

Hassan SH, Faez AM (2013): The Combination Effect of Lidocaine, Ketamine and Atracurium in Intravenous Regional Anesthesia KCMJ; 9(2): 61-63.

Flamer D, Peng PW. (2011). Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts. Local Reg Anesth 2011; 4:57–76. DOI: https://doi.org/10.2147/LRA.S16683

Wahba SS, Tammam TF.(2014). Intravenous regional anesthesia: effect of magnesium using two different routes of administration. Ain-Shams J Anaesthesiol; 7:65–69. DOI: https://doi.org/10.4103/1687-7934.128419

Bansal P, Baduni N, Bhalla J, Mahawar B.(2015). A comparative evaluation of magnesium sulphate and nitroglycerine as potential adjuncts to lidocaine in intravenous regional anaesthesia. Int J Crit Illn Inj Sci ; 5:27–31. DOI: https://doi.org/10.4103/2229-5151.152324

Tramer MR, Glynn CJ (2002). Magnesium Bier’s block for treatment of chronic limb pain: a randomized, double-blind, cross-over study. Pain; 99:235–241. DOI: https://doi.org/10.1016/S0304-3959(02)00105-7

Gorgias N, Maidatsi P, Kyriakidis A, Karakoulas K, Alvanos D, Giala M.(2001): Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lignocaine. Reg Anesth Pain Med ; 26: 512–517. doi: 10.1053/rapm. 2001.27857

Honarmand A, Safavi M, Nemati K, Oghab P. (2015): The efficacy of different doses of Midazolam added to Lignocaine for upper extremity Bier block on the sensory and motor block characteristics and postoperative pain. J Res Pharm Pract ; 4:160– 166. doi: 10.4103/2279-042X.162359. DOI: https://doi.org/10.4103/2279-042X.162359

Hegazy N, Elmetwaly K, Aboelseoud A, Alshaer A. (2010): Does the use of ketamine or nitroglycerin as an adjuvant to lignocaine improve the quality of intravenous regional anesthesia? Saudi J Anesth ; 4:55–62. doi: 10.4103/1658-354X.65122 DOI: https://doi.org/10.4103/1658-354X.65122

Esmaoglu A, Akin A, Mizrak A, Turk Y, Boyaci A.(2006): Addition of cisatracurium to lignocaine for intravenous regional anesthesia. J Clin Anesth. May; 18 [3]: 194-7. doi: 10.1016/j.jclinane.2005.08.003. DOI: https://doi.org/10.1016/j.jclinane.2005.08.003