Magnesium Sulfate versus Tramadol as Adjuvants to Lidocaine in Intravenous Regional Anesthesia for Carpal Tunnel Release Surgery: A Randomized Clinical Study

Abstract

Background: Intravenous regional anesthesia [IVRA] is a simple and effective anesthetic method for providing regional anesthesia of the upper limbs during carpal tunnel release surgery [CTRS]. However, the procedure is associated with significant postoperative pain and adjuvant analgesic agents are recommended. TheAim of The Work: This study aimed to compare the analgesic effects of magnesium sulfate and tramadol when added to lidocaine for IVRA during CTRS. Methods: In this double-blinded, randomized clinical trial, 60 ASA I-II patients eligible for elective CTRS with IVRA were randomly allocated into one of 3 groups. The first group [lidocaine group] received IVRA with 40 ml lidocaine 0.5%. The second group [lidocaine + tramadol group] received IVRA with40 ml 0.5% lidocaine and tramadol 1mg/kg. The third group [lidocaine + magnesium sulphate group] received IVRA with 40 ml 0.5% lidocaine and magnesium sulfate 10 mg/kg and normal saline. Outcome parameters included time to onset of sensory and motor block, time to onset of tourniquet pain, need of intraoperative analgesia, intraoperative consumption of fentanyl, duration of postoperative analgesia and pain intensity were noted in each patient.Results: Comparison between the studied groups regarding the outcome parameters. The Lidocaine + Tramadol and the Lidocaine + Magnesium groups achieved better performance in all the studied parameters in comparison to the Lidocaine group. In addition, Lidocaine + Tramadol groups had significantly better performance in comparison to the Lidocaine + Magnesium group. No significant differences were reported between the studied groups regarding post-operative complications Conclusions: Use of tramadol and magnesium sulphate as adjuvants to lidocaine achieved better performance in all the studied parameters in comparison to the lidocaine only. In addition, tramadol had significantly better performance in comparison to magnesium sulphate without significant side effects.

Comparison of adjuvant therapy with midazolam, paracetamol, tramadol, or magnesium sulfate during intravenous regional anesthesia with ropivacaine: A randomized clinical trial

“…[ 1 ] Based on our knowledge, its other huge benefit is perceived to include suitability, especially for outpatients, owing to the quick onset of anesthesia, the low probability of failure, the demonstrated fast recovery, and the easily controllable depth of anesthesia,[ 2 ] however, the limitations of the anesthesia, and most importantly, the development of tourniquet-related pain and the rapid development of posttourniquet release pain, especially in prolonged operations cannot be ignored. [ 3 ]…”

“…[ 4 ] A major focus of clinical research has been to address the co-administration of potent agents such as morphine, meperidine, magnesium sulfate, fentanyl, sufentanil, clonidine, and ketamine as adjuvants with a local anesthetic solution to provide prolonged postoperative analgesia. [ 3 5 6 7 ]…”