Bilge ASLAN, SEVAL İZDEŞ, Elvin KESİMCİ, Tülin GÜMÜŞ, Orhan KANBAK

İntravenöz rejyonal anestezide kullanılan lidokain, lidokain-tramadol ve lidokain-morfinin etkinliklerinin karşılaştırılması

AMAÇ: İntravenöz rejyonal anestezide (İVRA), tek başına lidokain ile lidokainin morfin ve tramadol ile kombinasyonlarının turnike ağrısına, duyusal, motor blok başlama ve geri dönüş zamanlarına, analjezi süresi ve düzeyi ile analjezik tüketimine etkileri karşılaştırıldı. GEREÇ-YÖNTEM: Etik kurulu izni ve hasta olurları alındıktan sonra, el ve ön kol cerrahisi uygulanacak 90 olgu çalışmaya dahil edildi ve rastgele yöntemle üç eşit gruba ayrıldı. Grup L’ye 40 ml %0.5’lik lidokain, Grup LT’ye 40 ml %0.5’lik lidokain + 1.5 mg.kg-1 tramadol, Grup LM’ye 40 ml %0.5’lik lidokain + 0.1 mg.kg-1 morfin uygulandı. Duyusal ve motor blok başlama ve dönüş zamanları, analjezi süresi, proksimal ve distal turnike süresi, ilk analjezik alma zamanı, vizüel analog skala (VAS), 24 saatlik analjezik tüketimi, vital bulgular ve yan etkiler kaydedildi. BULGULAR: Duyusal blok başlama süreleri Grup LM’de diğer iki gruba göre, Grup LT’de ise Grup L’ye göre anlamlı kısa; duyusal blok dönme süresi ise Grup L’de Grup LM’ye göre anlamlı olarak daha kısa olarak saptandı (p

Comparison of the effects of lidocaine, lidocaine plus tramadol and lidocaine plus morphine for intravenous regional anesthesia

OBJECTIVES: The aim of this study was to compare the effects of lidocaine alone and those of morphine or tramadol when added to lidocaine for intravenous regional anesthesia (IVRA) on tourniquet pain, the onset and regression time of motor and sensory block, the level and duration of analgesia, and analgesic consumption. METHODS: After institutional approval and informed consent, 90 patients scheduled for forearm or hand surgery were enrolled and randomly assigned to one of three groups for administration of either 0.5% lidocaine (Group L), 0.5% lidocaine with 1.5 mg.kg-1 tramadol (Group LT), or 0.5% lidocaine with 0.1 mg.kg-1 morphine (Group LM) in a volume of 40 ml. The onset and duration of sensory and motor blocks, duration of analgesia and proximal and distal tourniquet, time to first pain medication, visual analog scale (VAS) scores, analgesic requirements in 24 hours, vital signs, and side effects were recorded. RESULTS: Sensory block onset time was significantly shorter in Group LM compared with the other groups and also in Group LT compared to Group L. In addition, sensory block regression time was significantly shorter in Group L than in Group LM (p<0.05). There was a significant increase in VAS scores at the postoperative 4th and 5th hr in Group L (p<0.05). Mean arterial blood pressure was significantly reduced in Group LM at the time of tourniquet deflation (p<0.05). CONCLUSION: IVRA with lidocaine and morphine or tramadol improves postoperative analgesia and sensory block. However, these combinations provide no advantage on tourniquet pain, motor block quality, analgesia duration or analgesic consumption

PDF

___

1. Peng PW, Coleman MM, McCartney CJ, Krone S, Chan VW, Kaszas Z, et al. Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia. Reg Anesth Pain Med 2002;27:595-9.
2. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth 2002;49:32-45.
3. Lurie SD, Reuben SS, Gibson CS, DeLuca PA, Maciolek HA. Effect of clonidine on upper extremity tourniquet pain in healthy volunteers. Reg Anesth Pain Med 2000;25:502-5.
4. Gentili M, Bernard JM, Bonnet F. Adding clonidine to lidocaine for intravenous regional anesthesia prevents tourniquet pain. Anesth Analg 1999;88:1327-30.
5. Sakirgil E, Güneş Y, Ozbek H, Ozcengiz D, Balcioğlu O, Işik G. Comparison of ropivacaine, ropivacaine plus tramadol and ropivacaine plus morphine in patients undergoing minor hand surgery. Agri 2005;17:52-8.
6. Acalovschi I, Cristea T, Margarit S, Gavrus R. Tramadol added to lidocaine for intravenous regional anesthesia. Anesth Analg 2001;92:209-14.
7. Stein C, Yassouridis A. Peripheral morphine analgesia. Pain 1997;71:119-21.
8. Gupta A, Björnsson A, Sjöberg F, Bengtsson M. Lack of peripheral analgesic effect of low-dose morphine during intravenous regional anesthesia. Reg Anesth 1993;18:250-3.
9. Arendt-Nielsen L, Oberg B, Bjerring P. Laser-induced pain for quantitative comparison of intravenous regional anesthesia using saline, morphine, lidocaine, or prilocaine. Reg Anesth 1990;15:186-93.
10. Naguib M, Seraj M, Attia M, Samarkandi AH, Seet M, Jaroudi R. Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine. Can J Anaesth 1998;45:1168-75.
11. Altunkaya H, Ozer Y, Kargi E, Babuccu O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth 2003;90:320-2.
12. Alayurt S, Memis D, Pamukcu Z. The addition of sufentanil, tramadol or clonidine to lignocaine for intravenous regional anaesthesia. Anaesth Intensive Care 2004;32:22-7.
13. Langlois G, Estèbe JP, Gentili ME, Kerdilès L, Mouilleron P, Ecoffey C. The addition of tramadol to lidocaine does not reduce tourniquet and postoperative pain during iv regional anesthesia. Can J Anaesth 2002;49:165-8.
14. Tan SM, Pay LL, Chan ST. Intravenous regional anaesthesia using lignocaine and tramadol. Ann Acad Med Singapore 2001;30:516-9.
15. Erciyes N, Aktürk G, Solak M, Dohman D. Morphine/prilocaine combination for intravenous regional anesthesia. Acta Anaesthesiol Scand 1995;39:845-6.
16. Brown EM, McGriff JT, Malinowski RW. Intravenous regional anaesthesia (Bier block): review of 20 years’ experience. Can J Anaesth 1989;36(3 Pt 1):307-10.
17. Fukuda K. Intravenous opioid anesthetics. In: Miller RD, editor. 6th ed. Miller’s Anesthesia. Philadelphia: Elsevier; 2005. p. 380-438.
18. Mildh LH, Leino KA, Kirvelä OA. Effects of tramadol and meperidine on respiration, plasma catecholamine concentrations, and hemodynamics. J Clin Anesth 1999;11:310-6.
19. Unlugenc H, Ozalevli M, Gunes Y, Guler T, Isik G. Pre-emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery. Br J Anaesth 2003;91:209-13.
20. Keskinbora K, Aydinli I. An atypical opioid analgesic: tramadol.Agri 2006;18:5-19.