Intravenous regional anesthesia using lidocaine and neostigmine for upper limb surgery.
OBJECTIVE
To evaluate the effect of adding neostigmine to lidocaine in intravenous regional anesthesia (IVRA).


METHODS
Randomized, double-blinded study.


METHODS
Tertiary-care academic medical institution.


METHODS
40 ASA physical status I and II patients scheduled for elective or emergency forearm and hand surgery.


METHODS
Patients were randomized to two groups of 20 patients each. In the control group, IVRA was established using 40 mL of 0.5% lidocaine with one mL of isotonic saline, while neostigmine group patients received 40 mL of 0.5% lidocaine with 0.5 mg neostigmine.


METHODS
Hemodynamic parameters, onset and recovery times of sensory and motor blocks, and quality of anesthesia achieved with IVRA were recorded. After tourniquet deflation, visual analog pain scores (VAS) were noted every 30 minutes in the first two hours, as were the time to first analgesic request and total analgesic requirement in the 24-hour postoperative period.


RESULTS
In the first 24 hours after surgery, the neostigmine group had significantly lower VAS scores, longer time to first analgesic request, and reduced total analgesic requirement. Intraoperatively, the neostigmine group had significantly shorter sensory and motor block onset times and longer recovery times than the control group. No significant frequency of adverse effects was seen in either group. The quality of intraoperative anesthesia and frequency of tourniquet pain were similar in both groups.


CONCLUSIONS
The addition of neostigmine to lidocaine shortens onset time and improves postoperative analgesia in IVRA for upper limb surgery.
Sethi
Divya
D
Department of Anesthesia and Intensive Care, Safdarjang Hospital and Vardhman Mahavir Medical College (V.M.M.C), University of Delhi, New Delhi - 110029, India. divyasth@gmail.com
Wason
Rama
R
D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000494:pharmacology; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D009388:Neostigmine / Q000008:administration & dosage / Q000494:pharmacology*; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010277:Parasympathomimetics / Q000008:administration & dosage / Q000494:pharmacology*; D013997:Time Factors; D014111:Tourniquets / Q000009:adverse effects; D034941:Upper Extremity / Q000601:surgery; D055815:Young Adult
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D010277:Parasympathomimetics; D009388:Neostigmine; D008012:Lidocaine