Comparison of the Effect of Emla Cream, Subcutaneous Ring Anaesthesia and a Double Cuff Technique in the Prevention of Tourniquet Pain

Tsai, Yu‐Chuan; Lai, Y.-Y.; Chang, Chia Ling

doi:10.1093/bja/70.4.394

Cited by 33 publications

(6 citation statements)

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“…Skin compression,[26] tourniquet size,[27] inflation pressure,[28] and adjuvants in the LA solution[29] have been implicated as factors involved in tourniquet pain. Tourniquet pain is thought to be mediated by impulse propagation via small, unmyelinated, slow-conducting C fibers.…”

Section: Discussionmentioning

confidence: 99%

Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

et al. 2010

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Aims:To compare and evaluate the effect of adding ketamine or nitroglycerin (NTG) as adjuncts to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, sensorial and motor block onset times, and tourniquet pain.Settings and Design:A prospective, randomized, double-blind study was carried out.Materials and Methods:Seventy-five patients undergoing hand surgery were divided into three groups as follows: control group receiving lidocaine 2%, LK group receiving lidocaine 2% with ketamine, and LN group administered lidocaine 2% with NTG. Sensory and motor blocks' onset and recovery times were recorded. Visual analog scale (VAS) for tourniquet pain was measured after tourniquet application and it was also used to measure postoperative pain. Analgesic consumption for tourniquet pain and postoperatively were recorded.Results:Sensory block onset times were shorter in the LK (4.4 ± 1.2 minutes) and LN (3.5 ± 0.9 minutes) groups compared with the control group (6.5 ± 1.1 minute) (P < 0.0001) and motor block onset times were shorter in the LK (7.3 ± 1.6 minutes) and LN (3.6 ± 1.2 minutes) groups compared with the control group (10.2 ± 1.5 minutes) (P< 0.0001). Sensory recovery time prolonged in the LK (6.7 ± 1.3 minutes) and LN (6.9 ± 1.1 minutes) groups compared with the control group (5.3 ± 1.4 minutes) (P = 0.0006 and < 0.0001, respectively). Motor recovery time prolonged in the LK (8.4 ± 1.4 minutes) and LN (7.9 ± 1.1 minutes) groups compared with the control group (7.1 ± 1.3 minutes) (P = 0.0014 and 0.023, respectively). The sensory and motor block onset times were also shorter in LN group than in the LK group (3.5 ± 0.9 versus 4.4 ± 1.2 minutes, P=0.004; and 3.6 ± 1.2 versus 7.3 ± 1.6 minutes, P < 0.0001, respectively). The amount of fentanyl required for tourniquet pain was less in adjuvant groups when compared with control group. It was 13.6 ± 27.9 and 27.6 ± 34.9 µg in LK group and LN groups, respectively, versus 54.8 ± 28 µg in the control group. VAS scores of tourniquet pain were higher at 10, 20, 30, 40 minutes in the control group compared with the other study groups (P < 0.0001). It was also higher in LN group compared with LK group at 30 and 40 minutes (P < 0.001). Postoperative VAS scores were higher for the first 4 h in control group compared with the other study groups (P< 0.0001).Conclusions:The adjuvant drugs (ketamine or NTG) when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance and improving the postoperative analgesia in comparison to the control group. Ketamine as an adjuvant produced better tolerance to tourniquet than the other groups. NTG as an adjuvant produced faster onset of sensory and motor blockades in comparison to other groups.

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Section: Discussionmentioning

confidence: 99%

Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

et al. 2010

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“…In our clinical practice, IVRA is performed with a double tourniquet, which in comparison with other measures is effective in suppressing the superficial component of tourniquet pain. 13 The initial inflation of the proximal cuff interchanged by the inflation of the distal cuff, when anesthesia is established (10 minutes), is a sequence recommended to reduce the incidence of tourniquet pain. 14 The double-tourniquet equipment also allows the study drugs to exert their effect on sensory fibers, especially those innervating areas of tissue at or just proximal to the distal cuff.…”

Section: Discussionmentioning

confidence: 99%

Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine

Gorgias

2001

Regional Anesthesia and Pain Medicine

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“…Various methods have been investigated in an attempt to decrease tourniquet pain. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Clonidine (Cl) added to intrathecal bupivacaine has been shown to decrease tourniquet pain. 7 Intravenous regional anesthesia with clonidine (IVRA-Cl) has been shown to decrease tourniquet pain in patients undergoing surgery on the hand or forearm.…”

mentioning

confidence: 99%

Effect of clonidine on upper extremity tourniquet pain in healthy volunteers

Lurie

Reuben

Gibson

et al. 2000

Regional Anesthesia and Pain Medicine

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Comparison of the Effect of Emla Cream, Subcutaneous Ring Anaesthesia and a Double Cuff Technique in the Prevention of Tourniquet Pain

Cited by 33 publications

References 15 publications

Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia?

Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine

Effect of clonidine on upper extremity tourniquet pain in healthy volunteers

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