Research Article

Evaluating the Effects of Lidocaine Alone Versus Combination of Lidocaine with Pethidine for the Intravenous Regional Anesthesia in Upper Limb Soft Tissue Surgery

Abstract

Background: Intravenous regional anesthesia (IVRA) has been used as a common anesthetic technique for several types of operations. However, there are various concerns regarding the efficacy of this anesthetic method. The aim of this study was to evaluate the effects of lidocaine alone versus concomitant use of lidocaine and pethidine for the IVRA in upper limb surgery.
Methods: In this randomized, double-blind, controlled clinical, 50 eligible individuals were randomly divided to receive either a combination of 1.5 mg/kg lidocaine 2% and 1.5 mg/kg pethidine or placebo (3 mg/kg lidocaine 2%) for IVRA. After the surgery, the onsets and durations of sensory and motor block, the pain intensity in recovery room, the subjects' first demand of morphine, and the total amount of morphine injected within 24 hours were measured.
Results: The combination of lidocaine and pethidine was significantly effective in accelerating the onset of both sensory and motor blocks [(P=0.001), (P=0.001), respectively]. However, no differences were found between groups in sensory and motor block durations after surgery. Intervention with lidocaine plus pethidine caused a significant reduction of the pain intensity in recovery room (P=0.02). Also, concomitant use of lidocaine and pethidine led to a longer time of the first demand of morphine (P=0.04). Moreover, the total amount of morphine injected within 24 hours after surgery was considerably lower in individuals treated by lidocaine plus pethidine (P=0.003).
Conclusion: The results of the current study suggest that adding pethidine to lidocaine can be considered as an appropriate approach for better management of IVRA.

[1] Turan A, Memis D, Karamanlioglu B, Güler T, Pamukçu Z. Intravenous regional anesthesia using lidocaine and magnesium. Anesth Analg. 2005;100(4):1189-92.
[2] Mirkheshti A, Aryani MR, Shojaei P, Dabbagh A. 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. 2012; 3(9):616-21.
[3] 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):1181-4.
[4] Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth. 2002; 49(1):32-45.
[5] Desai SN, Santhosh M. A randomized, double blind comparison of pethidine and ketoprofen as adjuvants for lignocaine in intravenous regional anaesthesia. Braz J Anesthesiol. 2014;64(4):221-6.
[6] Verma R, Hasnain S, Sreevastava D, Murthy T. Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia. Med J Armed Forces India. 2016; 72(3):247-52.
[7] Singh R, Bhagwat A, Bhadoria P, Kohli A. Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries. Minerva Anestesiol. 2009; 76(2):109-14.
[8] Sen H, Kulahci Y, Bicerer E, Ozkan S, Dagl G, Turan A. The analgesic effect of paracetamol when added to lidocaine for intravenous regional anesthesia. Anesth Analg. 2009; 109(4):1327-30.
[9] Kerrigan S, Goldberger BA. Opioids. Principles of forensic toxicology: Springer; 2020. p. 347-69.
[10] Clark RF, Wei EM, Anderson PO. Meperidine: therapeutic use and toxicity. J Emerg Med. 1995;13(6):797-802.
[11] Armstrong P, Morton C, Nimmo A. Pethidine has a local anaesthetic action on peripheral nerves in vivo: addition to prilocaine 0.25% for intravenous regional anaesthesia in volunteers. Anaesthesia. 1993; 48(5):382-6.
[12] Tsui MH, Ngan Kee WD, Ng FF, Lau TK. A double blinded randomised placebo‐controlled study of intramuscular pethidine for pain relief in the first stage of labour. BJOG. 2004; 111(7):648-55.
[13] Unlugenc H, Vardar MA, Tetiker S. A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy. Anesth Analg. 2008; 106(1):309-12.
[14] Reuben SS, Steinberg RB, Lurie SD, Gibson CS. A dose-response study of intravenous regional anesthesia with meperidine. Anesth Analg. 1999; 88(4):831-5.
[15] Priyamani M, Sreekala K. Comparative Evaluation of Lignocaine 0.5% and Lignocaine 0.5% with Pethidine for Intravenous Regional Anaesthesia in Upper Limb Surgery. J Med Scie and Clinical Res. 2017;5(11):30309-15.
[16] Johnson CN. Intravenous regional anesthesia: new approaches to an old technique. CRNA. 2000; 11(2):57-61.
[17] Reuben SS, Steinberg RB, Lurie SD, Gibson CS. A dose-response study of intravenous regional anesthesia with meperidine. Anesth Analg. 1999; 88(4):831-5.
[18] Saryazdi H, Yazdani A, Sajedi P, Aghadavoudi O. Comparative evaluation of adding different opiates (morphine, meperidine, buprenorphine, or fentanyl) to lidocaine in duration and quality of axillary brachial plexus block. Adv Biomed Res. 2015; 4:232.
[19] Hasannasab B, Soleymani A, Matloub M, Amri P. Comparison of the effects of pethidine plus lidocaine and lidocaine alone on depth and duration of post operative analgesia in IV block of upper limb. Journal of Babol University of Medical Sciences. 2004; 6(2):25-9.
[20] Pauca A. Effect of pethidine premedication and halothane anaesthesia on upper limb blood flow. Br J Anaesth. 1992; 68(6):621-2.
[21] Enayati H, Moudi Z, Tirgar Fk, Dashipour A, Shahsavani A. A Comparison of Effects of Lidocaine 5%, Lidocaine 5% Plus Pethidine 5% And Pethidine 5% In Spinal Anesthesia for Cesarean Section. Zahedan Journal of Research in Medical Sciences. 2007; 9(2):77-85.
[22] Nishikawa K, Kanaya N, Nakayama M, Igarashi M, Tsunoda K, Namiki A. Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. Anesth Analg. 2000; 91(2):384-7.
[23] Sahmeddini MA, Khosravi MB, Seyedi M, Hematfar Z, Abbasi S, Farbood A. Comparison of magnesium sulfate and tramadol as an adjuvant to intravenous regional anesthesia for upper extremity surgeries. Anesth Pain Med. 2017; 7(6):e57102.
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IssueVol 9 No 1 (2023): Winter QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i1.11943
Keywords
Anesthesia Lidocaine Meperidine Morphine Analgesia

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How to Cite
1.
Amini A, Farbood A, Asadi S, Safari H, Ranjbar M. Evaluating the Effects of Lidocaine Alone Versus Combination of Lidocaine with Pethidine for the Intravenous Regional Anesthesia in Upper Limb Soft Tissue Surgery. Arch Anesth & Crit Care. 2022;9(1):40-45.