The analgesic effect of nitroglycerin added to lidocaine on quality of intravenous regional anesthesia in patients undergoing elective forearm and hand surgery

Abstract

PURPOSE:To evaluate the effect of nitroglycerine (NTG) on sensory and motor block onset and recovery time as well as the quality of tourniquet pain relief, when added to lidocaine (LID) for intravenous regional anesthesia in elective forearm and hand surgery. METHODS:A randomized double-blinded clinical trial was performed on 40 patients that were randomly allocated into two groups received lidocaine 3 mg/kg with NTG 200 µg or received only lidocaine 3 mg/kg as the control. RESULTS:There was no difference between the two study groups in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation. There was no difference in the mean of pain score over time between the two groups. The onset time of sensory and motor blockades was shorter in the group received both LID and NTG. The mean recovery time of sensory blockade was longer in the former group. The frequency of opioid injections was significantly lower in those who administered LID and NTG. CONCLUSION:The adjuvant drug of NTG when added to LID is effective in improving the overall quality of anesthesia, shortening onset time of both sensory and motor blockades, and stabling homodynamic parameters in hand and forearm surgery.

Nitroglycerin as Adjuvant to Two Different Doses of Lidocaine During IVRA for Hand Surgery

“…Additionally, NTG/LA combination allowed better PO course manifested as significantly lower scores at 1-hr PO and nonsignificantly lower scores till end thereafter and lower number of requests of rescue analgesia thus significantly shortened time of PO hospital stay. The obtained results go in hand with Asadi & Mehri [19] and Cakmak et al [20] who in similar comparative studies, found the onset time of sensory and motor blockades was shorter and mean recovery time of sensory blockade was longer with significantly lower opioid consumption in patients received NTG/LA combination versus LA only. Thereafter, Bansal et al [21] compared the efficacy of magnesium sulphate and NTG as adjuncts during IVRA and reported shorter sensory and motor block onset times and significantly prolonged recovery times with both drugs compared to lidocaine alone and concluded that addition of either of magnesium sulphate and NTG to lidocaine for IVRA lead to early onset of sensory block and prolonged PO analgesia.…”

“…In support of the safety of NTG, Honarmand et al [28] compared the effect and safety of IVRA using NTG/LA combination in three doses; 200, 300 and 400μg and detected superior effect of IVRA using NTG/ LA combination versus LA alone and no deleterious hemodynamic effects even with the high NTG dose which is double of the dose used in the present study. Thereafter, Asadi & Mehri [19] detected no difference between patients received NTG/LA combination or LA alone in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation.…”

The feasibility of using forearm intravenous regional anaesthesia instead of the standard upper arm technique in wrist and hand surgery

“…Regarding NTG, our results are in agreement with Sen et al [2] , who found that it accelerated the onset of sensory, and motor block, prolonged its duration, improved the quality of anesthesia, reduced tourniquet pain, and decreased the postoperative analgesic consumption without side effects. Abbasivash et al [16] , Asadi and Mehri [17] Elmetwaly et al [18] and Thombre et al [19] showed similar results. These effects were explained by the potent vasodilator effect of NTG which facilitates the diffusion of LA through small veins surrounding the nerves and then into the vasa nervorum and capillary plexus of the nerves, leading to a core-to-mantle (centrifugal) conduction block.…”

Does the Use of Nitroglycerin Patch Improve Local Anaesthetic Effects in Bier’s Block? A Double-Blind Placebo Controlled Study

“…Also, Asadi and Mehri [14] studied the analgesic effect of nitroglycerin when added to lidocaine for Bier's block on 40 patients scheduled for elective forearm and hand surgery and agreed our results by reporting shorter sensory block onset time and delay in sensory block recovery time after bandage release in the nitroglycerin group with shorter motor block onset time and delay in recovery time after bandage release in the first group; the frequency of opioid injections was significantly lower in those who administered lidocaine and nitroglycerin.…”