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

Elmetwaly, Khaled Fawzy; Hegazy, Nasr; Aboelseoud, Abdelkhalek Abdelmonem; Alshaer, Ahmad A

doi:10.4103/1658-354x.65122

Cited by 21 publications

(28 citation statements)

References 24 publications

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“…A conjoint administration of lidocaine with ketamine shortens the onset of anesthesia in mice and improves the anesthetic efficacy without prolonging the recovery time. 30,31 Besides, the addition of ketamine to epidural lidocaine or bupivacaine as an additive anesthetic has been identified to increase the duration of regional anesthesia and postoperative analgesia, and peri-incisional use of 0.3%-0.5% ketamine combined with local anesthetic in surgical wounds could enhance analgesia. 32 Pretreatment with a combination of intravenous lidocaine 40 mg and ketamine 25 mg is a more effective anesthetic than lidocaine 40 mg or ketamine 25 mg alone in preventing subsequent pain.…”

Section: Discussionmentioning

confidence: 99%

Effect of ketamine combined with lidocaine in pediatric anesthesia

Fang

Yang

et al. 2019

Clinical Laboratory Analysis

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Background:We conducted a randomized clinical trial to determine whether adjunctive lidocaine diminishes the incidence of adverse effects in pediatric patients sedated with ketamine. Methods:This case-control study involved 586 consecutive pediatric patients necessitating anesthesia. Then systolic blood pressure, heart rate, respiratory rate, and blood oxygen saturation were observed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN), and creatinine (Cr) levels were tested.General dose of ketamine, the time of onset and duration of anesthesia and postoperative recovery, anesthesia effect, and adverse reaction were subsequently compared. High-performance liquid chromatography was employed to detect ketamine concentration at different time points after administration, and the postoperative cognition function was further evaluated.Results: Intra-and post-operation, the rising degree of ALT, AST, BUN, and Cr in patients treated with ketamine was higher than those in patients treated with the ketamine-lidocaine complex. General dose of ketamine, the time of onset and duration of anesthesia, postoperative recovery time, and the incidence rate of adverse reaction in patients treated with ketamine-lidocaine complex were lower, but the concentration of ketamine was higher compared to the patients treated with ketamine. In patients treated with the ketamine-lidocaine complex, elimination half-life of ketamine was prolonged, the area under curve was increased, and the plasma clearance rate was decreased relative to those with ketamine alone. Conclusions:Ketamine combined with lidocaine may be beneficial in shortening the onset of anesthesia, promoting postoperative awake, prolonging elimination half-life, increasing area under curve, and decreasing plasma clearance rate and incidence of adverse reactions. K E Y W O R D S injectable anesthesia, ketamine, lidocaine, pediatric anesthesia S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Fang H, Li H-F, Yang M, et al. Effect of ketamine combined with lidocaine in pediatric anesthesia. J Clin Lab Anal. 2020;34:e23115. https ://doi.

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Section: Discussionmentioning

confidence: 99%

Effect of ketamine combined with lidocaine in pediatric anesthesia

Fang

Yang

et al. 2019

Clinical Laboratory Analysis

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“…Ketamine also has local anesthetic qualities, which have been studied as a sole agent for IVRA. [7] In addition to spinal cord NMDA receptors, NMDA receptors have also been identified on peripheral unmyelinated sensory axons. This can explain why ketamine as an NMDA receptor antagonist was able to attenuate the tourniquet pain.…”

Section: Discussionmentioning

confidence: 99%

Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study

Kumar¹,

Sharma²,

Datta³

2012

J Anaesthesiol Clin Pharmacol

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Introduction:Ketamine and dexmedetomidine decrease anesthetic requirement and provide analgesia to patients. We designed this study to compare the effect of dexmedetomidine and ketamine when added to lignocaine in intravenous regional anesthesia (IVRA).Materials and Methods:Seventy two patients undergoing hand surgery were randomly assigned to three groups to receive IVRA. They received 20 ml of 1% lignocaine and either 1 ml of isotonic saline (Group L, n = 24); or 0.5 mg/kg body weight ketamine (Group LK, n = 24) or 1 mcg/kg body weight dexmedetomidine (Group LD, n = 24). Sensory and motor block onset and recovery time were noted. After the tourniquet deflation, pain and sedation values, time to first analgesic requirement and any side effects were noted.Results:Shortened sensory and motor block onset times (69.17 min and 7.83 min respectively, P < 0.0001) and improved quality of anesthesia (satisfaction score = 3, P < 0.05) were found in ketamine group. Visual analog scale scores (3.21 ± 0.41) were comparable while time to first analgesic requirement (166.25 ± 25.89 min, P < 0.0001) was significantly longer in dexmedetomidine group after tourniquet release.Conclusion:We conclude that the addition of 1 mcg/kg of body weight dexmedetomidine or 0.5 mg/kg of body weight ketamine to lignocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects. We considered ketamine reduced the time for onset of block, delayed the onset of tourniquet pain, and reduced postoperative analgesic requirement and had a better patient satisfaction than placebo or dexmedetomidine.

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“…Elmetwaly et al [6] studied the effect of adding ketamine or nitroglycerin to lidocaine for Bier's block on seventy-five patients undergoing hand surgery and found that, in the control group, the starting four hours postoperatively, the VAS scores were higher compared with the other study groups. Also, Cakmak et al [5] noted and agreed these results by approving that, in Group C, the starting four hours postoperatively, the VAS scores were higher in comparison to other groups.…”

Section: Discussionmentioning

confidence: 99%

“…Several adjuncts have been used including narcotics, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, α 2 agonists, and neostigmine [6]. …”

Section: Introductionmentioning

confidence: 99%

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

Elgebaly

2018

Anesthesiology Research and Practice

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Aim The aim of the study was to assess the nitroglycerin patch as a new additive to Bier's block and its impact on the effects and dose of lidocaine. Methods Forty patients of each sex belonging to ASA I or II underwent elective tendon repair surgeries of the forearm and hand. The patients were divided into two equal groups as follows: Group C received only lidocaine (1.5 mg/kg, 0.25%) and Group N received lidocaine (1.5 mg/kg, 0.25%) + 5 mg transcutaneous nitroglycerin patch. Onset and recovery times for sensory and motor block, visual analogue scale (VAS) scores for bandage pain, postoperative VAS score, analgesic requirements, patients' satisfaction, and surgeons' opinion were recorded. Results Sensory block onset time was shorter in Group N (3.80 ± 1.0) than that in Group C (5.72 ± 1.46), and motor block onset time was shorter in Group N (10.72 ± 1.93) than that in Group C (13.56 ± 1.26). Sensory block recovery time was prolonged in Group N (10.56 ± 1.12) than Group C (6.88 ± 1.45), recovery time of motor block was prolonged in Group N (13.04 ± 1.57) than Group C (11.96 ± 1.72). Bandage pain had lower VAS scores in Group N. Postoperative VAS scores showed significant differences between both groups at the following points of measurement: 30 minutes, 1 hour, and 4 hours after bandage deflation. Postoperative analgesic effect was the longest in Group N (187.20 ± 60.79 min) than Group C (51.60 ± 25.28 min). Patients' satisfaction and surgeons' opinion were better in Group N than Group C. Conclusion Supplementation of Bier's block with transcutaneous nitroglycerin patch reduces the lidocaine dose, the sensory and motor block onset times, VAS scores, and analgesic consumption intra- and postoperatively. Length of the block recovery times for the sensory and motor effects, duration of postoperative analgesic effect, and the first time to analgesic requirement improved the quality of Bier's block with better patients' satisfaction and surgeons' opinion and had no adverse effects.

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

Cited by 21 publications

References 24 publications

Effect of ketamine combined with lidocaine in pediatric anesthesia

Effect of ketamine combined with lidocaine in pediatric anesthesia

Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study

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

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