Al-Azhar Assiut Medical Journal (Jan 2018)
Lornoxicam versus nitroglycerine as adjuvants to lidocaine in intravenous regional anesthesia by using a single forearm tourniquet
Abstract
Background Intravenous regional anesthesia (IVRA) is an old anesthetic technique for surgical procedures on the upper and lower limbs. It is a safe and effective type of anesthesia for hand surgery of 1 h duration or less. There are many modifications of IVRA due to tourniquet pain, and intraoperative and postoperative analgesia. Objective The objective of this study was to assess the effectiveness of lornoxicam and nitroglycerine as adjuvants to lidocaine in IVRA by using single forearm tourniquet in cases of hand surgeries. Patients and methods Seventy-five patients undergoing hand surgeries where randomly classified into three equal groups: group L received 20 ml of lidocaine 1% with 2 ml normal saline; group LL received 20 ml of lidocaine 1% with lornoxicam 8 mg (2 ml); and group LN received 20 ml of lidocaine 1% with nitroglycerine 100 µg (2 ml). Results The onset time of sensory and motor blocks was statistically significantly shorter in the nitroglycerine group (3.2±0.2 and 3.7±0.9 min, respectively) than other groups. The onset time of tourniquet pain was delaying in group LL than other groups. There was statistically significant increase in the duration of postoperative analgesia in group LL (90.35±5.72 min) compared with groups LN (48.55±0.52 min) and L (25.7±2.7 min). There were statistically significant increases in patient and surgeon satisfactions in group LN in comparison with groups LL and L. Conclusion The addition of lornoxicam and nitroglycerine to lidocaine for IVRA improves the speed of onset and the quality of anesthesia, decreases tourniquet pain, and decreases the analgesic requirements during the first 24 h postoperatively without side effects. The addition of lornoxicam to lidocaine was superior in delaying the onset of tourniquet pain and delaying the postoperative analgesia request. The single forearm tourniquet is safe with no obvious side effects.
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