The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia

Abstract

We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 mug NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 +/- 1.1 versus 4.5 +/- 1.2 min; P = 0.01 and 3.3 +/- 1.6 versus 5.2 +/- 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 +/- 1.6 versus 3.1 +/- 1.2 min P < 0.0001 and 7.3 +/- 1.3 versus 3.6 +/- 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 +/- 74 min versus 39 +/- 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.

Analgesic Effects of Additional Nitroglycerine in Intravenous Regional Lidocaine-Based Anesthesia Through Forearm Surgery

“…Sen et al (11) reported shortened onset times for sensory and motor block, which was lower than what we found.…”

The analgesic effect of three different doses of nitroglycerine when added to lidocaine for intravenous regional anesthesia in trauma patients

“…[1,3] Different additives such as opioids, tramadol, nonsteroidal antiinflammatory drugs, dexmedetomidine, and muscle relaxant have been combined with LAs to improve block quality, prolong post-deflation analgesia and decrease tourniquet pain. [1,3,4] Sen and colleagues [5] showed that the addition of 200 µg nitroglycerine (NTG) to lidocaine for IVRA improves sensory and motor block, tourniquet pain and postoperative analgesia without side effects. They emphasized that more studies with different doses must be performed to determine a relevant conclusion before the routine use of NTG.…”

“…[5] They reported that postoperative VAS scores were significantly lower for the first 4 h postoperatively in Group NTG, in which 200 µg NTG was added to IVRA. The limitation of their study was using only one low dose of NTG (200 µg).…”

“…Based on Sen et al's study, [5] a sample size of 25 in each group will have 80% power to detect a difference in the mean amount of intraoperative fentanyl requirement of 17.9 µg using a twogroup t-test with a 0.050 two-sided significance level.…”

Dose Addition of Tramadol to Levobupivacaine Femoral Nerve Block Prolong Its Analgesic Efficacy in Patients Undergoing Anterior Cruciate Ligament Reconstruction?

“…Many additives can be used for prolongation of the duration of regional blockade. eg,dexamethasone, magnesium sulphate clonidine, nitroglycerin [5][6][7][8]. Tramadol hydrochloride is analgesic drug acting at central and peripheral m-opioid and monoaminergic receptors [9].…”