Comparison of the effects of acetaminophen to ketorolac when added to lidocaine for intravenous regional anesthesia

Abstract

BackgroundThis study was done to evaluate the effect on pain relief when acetaminophen was added to lidocaine for intravenous regional anesthesia (IVRA).MethodsSixty patients undergoing hand or forearm surgery received IVRA were assigned to three groups: Group C received 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml (n = 20), Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml (n = 20) and Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketorolac 10 mg made up to a total volume of 40 ml (n = 20). Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed.ResultsSensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C (P < 0.001).ConclusionsThe addition of acetaminophen to lidocaine for IVRA shortens the onset time of sensory block and delays tourniquet pain onset time, but not with ketorolac. Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.

Perioperative Intravenous Acetaminophen and NSAIDs

“…The authors observed that i.v. APAP added to a standard IVRA block could shorten onset time to sensory block, but APAP or ketorolac produces comparable postoperative pain relief [125].…”

“…In Ko et al. [125], 60 patients undergoing elective hand or forearm surgery were randomly assigned to one of three groups: the control group (C) received 0.5% lidocaine diluted with normal saline to 40 mL volume (n = 20) as an i.v. regional anesthesic block (IVRA); the APAP group (P for paracetamol) received IVRA lidocaine and APAP 300 mg admixture with saline to 40 mL (n = 20); and the ketorolac group (K) received IVRA lidocaine and ketorolac 10 mg admixture with saline to 40 mL (n = 20).…”

“…Tramadol 50 mg was given for pain scores >3. Total tramadol consumption was recorded for the 2 hours in the PACU [125].…”

The Analgesic Effect of Dexketoprofen When Added to Lidocaine for Intravenous Regional Anaesthesia: A Prospective, Randomized, Placebo-Controlled Study

“…Numerical pain rating scale: 0, no pain; 10, worst pain imaginable. 3,5,7 to be effective adjuncts for IVRA, reducing tourniquet pain and prolonging postoperative anaesthesia. 2 -7 The mechanism of action of NSAIDs is commonly believed to be via inhibition of the cyclo-oxygenase (COX)-2 enzyme and a subsequent decrease in prostaglandin levels 22 that are normally upregulated by surgical trauma.…”

Comparison of the Effects of Lignocaine, Lignocaine Plus Paracetamol, Lignocaine Plus Tramadol in Intravenous Regional Anesthesia

“…Chakole V et al [11] conducted a study with lignocaine 0.5% and tramadol 100 mg demonstrated that postoperatively consumption of rescue analgesic doses was significantly lower in tramadol group than lignocaine group. Ko MJ et al [12] study concluded that addition of acetaminophen to lidocaine for IVRA reduces postoperative analgesic consumption. The results were in accordance with our study.…”