Abdülkadir ATIM, Oğuz KILIÇKAYA, Tarık PURTULOĞLU, Hüseyin ŞEN, Memduh YETIM, Serkan BİLGİÇ, Ercan KURT, Alparslan TURAN

Metamizole (dipyrone) as an additive to lidocaine for intravenous regional anesthesia

Amaç: Nonsteroid antiinflamatuvar ilaçlar (NSAII) intravenöz rejyonal anesteziye (IVRA) eklendiğinde analjezik etki süresinin aynı dozda parenteral kullanımına göre daha uzun olduğu gösterilmiştir. Potent bir NSAII olan metamizolün aynı zamanda periferal analjezik etkilere de sahip olduğu gösterilmiştir. Ancak metamizol daha önce IVRA'ya eklenerek çalışılmamıştır. Bu amaçla biz İVRA'ya metamizol ekleyerek ağrı skorunu düşüreceğimiz ve blok kalitesini arttırabileceğimiz hipotezini test ettik. Gereç ve Yöntem: El cerrahisi geçirecek 75 hasta randomize olarak üç gruba ayrıldı. Tüm gruplara benzer IVRA solüsyonu ( Toplam 40 ml serum fizyolojikle sulandırılmış Lidokain 3 mg kg'1) verildi. Grup L'de IVRA solüsyonu ve iv serum fizyolojik verildi. Grup L/M' de İVRA solüsyonuna 500 mg metamizol karıştırılarak verildi. Grup ivM'de IVRA solüsyonuna ek olarak IV 500 mg metamizol ayrı olarak verildi. İlk 24 saatte duyusal ve motor blok zamanları, turnike ağrısı ve ameliyat sırasında analjezik kullanımı kaydedildi. Turnikenin indirilmesinden sonra ağrı skorları, ilk analjezik gereksinimi, 24 saatteki toplam analjezik tüketimi ve yan etkiler kaydedildi. Bulgular: Turnikenin şişirilmesinden sonra ve postoperatif birinci saatte grup ivM'de diğer gruplarla, karşılaştırıldığında ağrı skorları anlamlı düzeyde düşük bulundu (p0,05). İntraoperatif fentanil tüketimi ve postoperatif total diklofenak kullanımı gruplar arasında benzer bulundu (p>0,05). Motor ve duyusal blok başlangıç ve geri dönüş zamanları arasında istatistiksel olarak bir farklılık bulunamadı (p>0,05). Anestezi kalitesi gruplar arasında anestezist, cerrah ve hasta memnuniyeti açısından benzer bulundu (p>0,05).

İntravenöz rejyonal anestezide lidokaine eklenen metamizol (dipiron)

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) as adjuncts to Intravenous regional anesthesia (IVRA) demonstrated analgesic effect lasting longer than the same parenteral dose. Metamizole is a potent NSAID which demonstrates peripheral analgesic properties as well. However, metamizole has not been previously studied as an additive for IVRA. We therefore tested the hypothesis that addition of metamizole to IVRA solution will decrease pain scores and improve the quality of the block. Material and Method: Seventy five patients undergoing hand surgery were randomly divided into three groups. Similar IVRA solution (lidocaine 3 mg kg' diluted with saline to a total volume of 40 ml) was given to all groups. Group L received IVRA solution plus IV saline, Group L/M received IVRA solution and metamizole (500 mg) admixture plus iv saline, and Group ivM received IVRA solution plus iv metamizole (500 mg). Sensory and motor block onset time, tourniquet pain, and analgesic use were assessed during the operation. After tourniquet deflation, pain scores, time to first analgesic requirement, total analgesic consumption in 24 h, and side effects were noted. Results: Pain scores after inflation of tourniquet and postoperative I hr was significantly lower in group ivM compared to other groups (p<0.05). In all other measurement times including the postoperative period there was no difference between the groups (p>0.05). Intraoperative fentanyl consumption and postoperative total amount of diclofenac use were similar between groups (p>0.05). There were no statistical differences in onset and recovery of sensory plus motor blocks between the groups (p>0.05). The quality of anesthesia reported by the anesthesiologist, surgeon and patient were similar between the groups (p>0.05). Conclusions: The addition of metamizole to IVRA solution did not provide clinically significant improvement in pain scores and quality of the block.

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