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Fentany and pancuronium as adjuncts to lignocaine for IVRA
- Ashok Kumar Bangalore Puttappa, Dr Geeta A Patkar (15 December 2005)
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Ashok Kumar Bangalore Puttappa, Anaesthetics Lokamanya Tilak Municipal Hospital,Bombay, Dr Geeta A Patkar
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Further to the article on mepivacaine and liganocaine I am interseted in sharing our experience with intravenous regional anaesthesia (IVRA) IVRA . In our local hospital, mepivacaine is not used.However we have done a study on Lignocaine and additives . In this prospective randomized double blind study, 75 patients of ASA grade 1 and 2 undergoing surgery over forearm and hand were studied to compare the effect of lignocaine 0.5% (Group L, n=25)with lignocaine 0.25% plus fentanyl 1microgram/kg (Group F, n=25) and lignocaine 0.25%plus fentanyl 1micogramg/kg plus pancuronium 0.5mg (Group P, n=25) with respect to time of onset of sensory block, motor block, degree of muscle relaxation, operative condition, intraoperative analgesia, hemodynamic studies, post operative analgesia ,side effects and complications. 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 1microgram/kg , and in patients of group P 1.5mg/kg of 0.25% lignocaine combined with fentanyl 1microgram/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 showed excellent muscle relaxation and intraoperative analgesia. Postoperative 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. No major untoward side effects were noticed. Thus from the present study, we conclude that the addition of fentanyl 1micogramg/kg and pancuronium 0.5mg to 0.25% of lignocaine enhances lignocaine action and results in better sensory and motor block, excellent intraoperative analgesia and introperative muscle relaxation.The strategy can be used to reduce the total dose of lignocaine, which can thus be kept at nontoxic levels without compromising the quality of IVRA. 1) Elhakim M and Sadek R.A., “Addition of atracurium to lidocaine for intravenous regional anaesthesia”, Acta anaesthesiol Scand 1994; 38; 542 – 4. 2) Reuben S.S,Steinberg RB ,Kreitzer JM and Duprat KM . “Intravenous Regional Anaesthesia Using Lidocaine and Ketorolac”, Anesthesia & Analgesia 1995; 81; 110 – 2. Conflict of Interest:None declared |
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