The effect of adding nitroglycerine as an AS adjuvant to lidocaine on pain and Hemodynamic Variables of intravenous regional anesthesia upper extremity surgery

Background and

Intravenous regional anesthesia (IVRA) is a simple and reliable method for upper extremity injuries. Different additives have been combined with local anesthetics to improve block quality، decrease tourniquet pain and postoperative analgesia in IVRA. This study was performed to evaluate the effect of (NTG) in quality improvement when added to lidocaine in IVRA.

In a clinical trial، 40 patients ASA (American Society of Anesthesiologists) I-II، the candidates with upper extremity injury were scheduled for IVRA randomly allocated into two groups. Under identical condition، the control group received 3mg/kg mg lidocaine %0. 5 and the study group received 3mg/kg mg lidocaine %0. 5 plus 200µg nitroglycerine. Hemodynamic variables were measured and recorded at 5، 10، 15، 20، and 30 min after anesthetic solution administration. The onset and recovery times of sensory and motor block were measured and recorded and tourniquet pain based on visual analog scale (VAS) score in all patients. After the tourniquet deflation، at 30 min and 2، 4، 6 and 12 h، hemodynamic variables، VAS score، total analgesic consumption in the first 24 h after operation، and the side effects were noted.

Sensory block onset time was less in NW in comparison with the control group (2. 45±0. 51042 vs 4. 35±1. 26803) Sensory and motor recovery times were prolonged in NW group compared to the control group (8. 25±2. 1734 vs 3. 825±0. 99041 min) for sensory، (4. 2000±1. 15166 vs 3. 025±0. 80255 min) for motor recovery with statistical significance (P<0. 05). The onset time tourniquet pain was prolonged in NW in comparison with the control group (22. 5±3. 12039 vs 19. 4±2. 77963 min). Pulse rate at 0. 5، 2 and 4 hr postoperatively was lower in the study group (P<0. 05). Postoperative analgesia after 0. 5h of tourniquet deflation was prolonged with statistically significant difference in VAS scores (1. 1±0. 30 vs 1. 05±0. 22).

Totally، according to the obtained results، it may be concluded that the use of nitroglycerine added to lidocaine would result in an increase in the effect of anesthetic without additional adverse effects.