INTRAVENOUS REGIONAL ANESTHESIA (BIERS BLOCK);

TO COMPARE THE ANALGESIC EFFECTS OF COMBINATION OF 0.5% LIDOCAINE PLUS KETROLAC IN INTRAVENOUS REGIONAL ANESTHESIA TECHNIQUE WITH THOSE OF LIDOCAINE 0.5 % ALONE TO PREVENT POST OPERATIVE PAIN

Abstract

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regional
anaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biers
block). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,
Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: The
study was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients were
divided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of
200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.
The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30
minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, was
compared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 females
were enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03
years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classified
as ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scores
as compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groups
at 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,
0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocaine
in intravenous regional anaesthesia.