Intravenous Regional Anaesthesia With Lignocaine, Fentanyl And Pancuronium -- Prospective Randomised Controlled Double Blind Study

Puttappa, Ashok Kumar B.; Patkar, Geeta
September 2010
Internet Journal of Anesthesiology;2010, Vol. 24 Issue 2, p1
Academic Journal
Intravenous Regional Anaesthesia (IVRA) is a simple and effective technique for upper limb distal surgery. However, a relatively large dose of LA is required to induce motor and sensory blockade. Lignocaine 3mg/kg as a 0.5% solution is needed to ensure adequate analgesia. Systemic toxic reactions (convulsions, coma, cardiac arrest) can occur when the tourniquet deflates unexpectedly during the procedure or when it deflated intentionally at the end of short surgery. Therefore we conducted this prospective randomized double blind study to compare and evaluate the effects of addition of fentanyl and pancuronium to reduced dose of LA against the standard practice of 0.5% lignocaine. In this study, 75 patients of both sexes in the age group more than 18 years belonging to ASA 1 and 2 undergoing both elective and emergency surgeries of the forearm and hand were divided randomly into group L, group P and group F with 25 patients in each group.In patients belonging to group L, 40 cc of 3mg/kg of 0.5% lignocaine diluted in normal saline was used for administering IVRA, and in patients of group F 40 cc of 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1mg/kg , and in patients of group P 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1mg/kg and pancuronium 0.5mg was used. The time for onset of sensory blockade in group L was 11.76.± 3.08 minutes , group F was 12.96±3.06 minutes , and group P was 10.20±3.52 minutes which was clinically comparable in all the groups. However the time for onset of motor blockade was significantly delayed in group F (21.1±2.7 minutes) as compared to other two groups: group L (12.5±2.6minutes and group P (11.36±3.5 minutes). The patients in group P were showing significantly excellent muscle relaxation and excellent intraoperative analgesia as compared to other two groups. Post operative analgesia in group P (56.4±2.6minutes ) was significantly longer as compared to group F (46.8 ±4.9 minutes) and group L (39 ± 8 minutes). Our results showed that hemodynamic parameters like pulse rate, blood pressure, respiratory rate were well maintained throughout the intra and post operative period in all the patients of all the groups. There were no major untoward side effects were noticed.Thus from the present study, we conclude that the addition of fentanyl 1mg/kg and pancuronium 0.5mg to 0.25% of lignocaine enhances lignocaine action and results in-Adequate sensory and motor block.-Excellent intraoperative analgesia.-Excellent intraoperative muscle relaxation. Thus, using this combination the dose of lignocaine for IVRA can be reduced to a non toxic level for the same quality of analgesia and at the same time not offer any post analgesic benefit as all study patients were required supplement of analgesics post operatively after about 50-60 minutes.



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