Effect of Addition of Cisatracurium to Lignocaine versus plain Lignocaine for Intravenous Regional Anesthesia; A Quasi Experimental Study
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-1.11429Keywords:
Cisatracurium, Intravenous Anesthesia, Lignocaine, Regional.Abstract
Objective: To compare the efficacy and safety of the addition of Cisatracurium to Lignocaine versusplain Lignocaine for IVRA.
Study Design: Quasi experimental study.
Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2023.
Methodology: Forty-four patients undergoing elective hand surgery were randomly assigned to two groups of 22 patients each. All demographic details were noted, all were briefed about VAS (0 to 10) for pain. Group 1 received Lignocaine 2%; Group 2 received Cisatracurium plus Lignocaine 2%. Standard technique was employed for IVRA. Following were assessed: onset and offset of sensory and motor block, quality of anesthesia using a numerical scale scored 1-4, postoperative pain using VAS measured at 5-minute,1, 2, 4, 8 hours and the time to first analgesic request.
Results: The onset times of sensory & motor blocks were significantly shorter (p=0.001 & p<0.001) and the regression times of sensory & motor blocks were prolonged (p=0.003 & p<0.001) in group B compared with the group A. The Cisatracurium group had better quality of anesthesia (p<0.001). Overall, lower mean VAS pain scores were recorded after tourniquet deflation and longer time to the first analgesic request (p<0.001) was recorded in Cisatracurium group post-operatively.
Conclusion: The addition of Cisatracurium to Lignocaine in IVRA, shortened the block onset times, prolonged the block offset times, improved the quality of anesthesia & decreased the post-operative pain & time to first analgesic requirement.
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1. Prabhakar A, Lambert T, Kaye RJ, Gaignard SM, Ragusa J, Wheat S, et al. Adjuvants in clinical regional anesthesia practice: A comprehensive review. Best Pract Res Clin Anaesthesiol 2019; 33[4]: 415-423. http://doi.org/10.1016/j.bpa.2019.06.001
2. Kraus GP, Rondeau B, Fitzgerald BM. Bier Block. [Updated 2023 Aug 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
3. Holmes CM. Intraveneus regional analgesia. A useful method of producing analgesia of the limbs. Lancet 1963; 1(7275): 245-247.
https://doi.org/10.1016/s0140-6736(63)90954-1
4. Esmaoglu A, Akin A, Mizrak A, Turk Y, Boyaci A. Addition of Cisatracurium to Lignocaine for intravenous regional anesthesia. J Clin Anesth 2006; 18(3): 194-197.
https://doi.org/10.1016/j.jclinane.2005.08.003
5. Farbood A, Khademi S, Tajvidi R, Hooshangi M, Salari S, Ghani M, et al. 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.
http://doi.org/10.30476/ BEAT. 2020.46446
6. A Prippenow G, Fruhstorfer H, Seidlitz P, Nolte H. [Addition of muscle relaxants to intravenous regional anesthesia]. Reg Anaesth. 1985; 8(2): 15-20.
7. Abdelnaser MA, Magdy HA, Elsawy MA, FetouhA. Effect of Adding Different doses of Atracurium to Lignocaine on the Quality and Safety of Local Intravenous Anaesthesia for Upper Extremities Surgery; Med. J. Cairo Univ., 2022; 90(8): 2747-2753.
8. Arslanian B, Mehrzad R, Kramer T, Kim DC. Forearm Bier block: a new regional anesthetic technique for upper extremity surgery. Ann Plast Surg 2014; 73(2): 156–157.
9. Chiao FB, Chen J, Lesser JB, Resta-Flarer F, Bennett H. Single-cuff forearm tourniquet in intravenous regional anaesthesia results in less pain and fewer sedation requirements than upper arm tourniquet. Br J Anaesth 2013; 111(2): 271–275.
10. Hany K. Mickhael MD. & Abeer A.M. Hassanin MD. Effect of Addition of Cisatracurium or Cisatracurium and Ketorolac to Lignocaine for Local Intravenous Anaesthesia. Eg J Anaesth. 2009; 25(2): 139-145
11. Chan VW, Peng PW, Kaszas Z, Middleton WJ, Muni R, Anastakis DG, et al. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis. Anesth Analg 2001; 93(5): 1181-1184.
https://doi.org/10.1097/00000539-200111000-00025
12. Flamer D, Peng PW. Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts. Local Reg Anesth 2011; 25: 57-76.
https://doi.org/10.2147/LRA.S16683
13. Subramanya V, Kapinigowda ST, Math AT, Chennaiah VB. Dexmedetomidine as an adjuvant for intravenous regional anesthesia in upper limb surgeries. Anesth Essays Res 2017; 11(3): 661. https://doi.org/10.4103/0259-1162.206851
14. Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases. 2017; 5(8): 307.
https://doi.org/10.12998/wjcc.v5.i8.307
15. Mekkawy SM, Youssef HA, Sleem AM, AboElfadl GM. Atracurium mixed with magnesium sulfate versus atracurium alone as adjuvant to Lignocaine in intravenous regional anesthesia: A randomized clinical trial. J Curr Med Res Pract 2021; 6(1): 58-64.
https://doi.org/10.4103/JCMRP.JCMRP_115_19
16. Magdy HA, Mohamed AA, Ahmed F, Mohamed AE. Effect of Adding Different doses of Atracurium to Lignocaine on the Quality and Safety of Local Intravenous Anaesthesia for Upper Extremities Surgery. Me J Cairo Uni 2022; 90(12): 2747-2753.
https://doi.org/10.21608/MJCU.2022.296225
17. Carabetta SM, Allen B, Cannon C, Hailu K, Johnson T. Atracurium Versus Cisatracurium in the Treatment of Acute Respiratory Distress Syndrome. J Pharm Technol 2023; 39(5): 212-217. https://doi.org/10.22159/ijcpr.2023v15i4.3026
18. Kurt N, Kurt I, Aygünes B, Oral H, Tulunay M. Effects of adding alfentanil or atracurium to Lignocaine solution for intravenous regional anaesthesia. Eur J Anaesthesiol 2002; 19(7): 522-525.
19. Diaz LL, Zhang J, Heerdt PM. Comparative pharmacodynamics of Pancuronium, Cisatracurium, and CW002 in rabbits. Journal of the American Assoc Lab Animal Sci 2014; 53(3): 283-289.
https://doi.org/10.1017/S0265021502000856
20. Elhakim M, Sadek RA. Addition of atracurium to Lignocaine for intravenous regional anaesthesia. Acta Anaesthesiol Scand. 1994; 38(6): 542-544. https://doi.org/10.1111/j.1399-6576.1994.tb03948.x
21. Arafa M, Abdelmotableb NA, Ragab AS. Atracurium with or without Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia in Upper Limb Surgeries. Int J Med Arts. 2021; 3(1): 913-921.
https://doi.org/10.21608/IJMA.2021.142227
22. Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, et al. Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study. Advan Ther 2020; 37: 527-540.
https://doi.org/10.1007/s12325-019-01171-6
23. Khan RM, Kaul N, Nair RG. Cisatracurium degradation: Intravenous fluid warmer the culprit?. Indian J Anaesth 2015; 59(5): 323.
https://doi.org/10.4103/0019-5049.156893
24. Carr DB. Regional anesthesia and ischemic pain: go with the flow. Pain Med 2014; 15(2): 182-183.
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