Effect on Postoperative Analgesia of Small-Dose Lysine Acetylsalicylate Added to Prilocaine During Intravenous Regional Anesthesia

Abstract

Nonsteroidal antiinflammatory drugs act largely peripherally by blocking the local synthesis of prostaglandins. The aim of this study was to evaluate whether the addition of a small dose of lysine acetylsalicylate (LA) to the prilocaine used for intravenous regional anesthesia (IVRA) would improve the quality of postoperative analgesia. Sixty patients undergoing lower extremity IVRA for foot or ankle surgery were randomly assigned to three double-blind groups: LA-IVRA where 90 mg of LA was mixed with prilocaine 0.5% for IVRA and 1 mL of 0.9% NaCl administered intravenously (IV) through the forearm catheter after tourniquet inflation; LA-IV where 1 mL of 0.9% NaCl was mixed with prilocaine and 90 mg of LA administered IV; and placebo where 1 mL of 0.9% NaCl was administered both with prilocaine for the IVRA and IV. Duration of analgesia (time elapsed between tourniquet release and first injection of morphine, expressed as mean +/- SD) was significantly longer (P < 0.05) in LA-IVRA (387 +/- 216 min) when compared with LA-IV (175 +/- 264 min) and placebo (126 +/- 201 min). Analgesic requirements remained significantly lower in LA-IVRA when compared with placebo only during the first six postoperative hours, LA-IV being in an intermediate position. Pain scores were significantly lower in LA-IVRA during the first postoperative hour when compared with LA-IV and during the first 3 postoperative hours when compared with placebo. We conclude that 90 mg of LA (corresponding to 50 mg of acetylsalicylic acid) added to prilocaine 0.5% during IVRA improves the quality of postoperative analgesia in the early postoperative period.

A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures

“…19 Three studies had a systemic control group. 17,18,20 All of these studies were supportive in terms of postoperative outcome.…”

“…8 Ten studies investigated opioids [6][7][8][9][10][11][12][13][14][15] and one tramadol 1 6 (Table I). Six studies investigated non-steroidal antiinflammatory drugs (NSAIDs) 8,[17][18][19][20][21] and five clonidine 8,[22][23][24][25] (Table II). Five studies investigated muscle relaxants, 6,7,[26][27][28] three alkalization, [29][30][31] one potassium 3 2 and two temperature 33,34 (Table III).…”

“…Six studies involving 370 patients have investigated various NSAIDs as the sole adjunct 8,[17][18][19][20][21] to IVRA (Table II). The agents investigated were ketorolac, 17,19,21 tenoxicam 8,18 and aspirin.…”

“…One study 20 involving 60 patients looked at acetylsalicylate 90 mg as an adjunct. Again, only the postoperative course was investigated.…”

The Efficacy of Adding Lornoxicam-Dexmedetomidine to 0.25% Diluted Lidocaine for Intravenous Regional Anesthesia

“…Lornoxicam is a NSAID belongs to the oxicam class, it has antiinflammatory analgesic, and antipyretic properties [11]. Adding lornoxicam to local anesthetics provides better postoperative analgesia and patient comfort, and decreases the need for opioid [12].…”