Reduction dose of local anesthetic drugs by Paracetamol or ketamine in intravenous regional anesthesia; comparative study.

Abstract

Background: Intravenous Regional Anesthesia (IVRA) is a simple and effective technique for both limbs’surgical procedures. However, a relatively large dose of local anesthetic drug is needed to achieve motor and sensory blockade. Lignocaine 3mg/kg is used to ensure adequate analgesia. Aim of the study: To compare and evaluate the effects of addition of ketamine or paracetamol with less dose of local anesthetics against the standard practice of using high total dose of lignocaine. Location and date of study: Basra General Hospital / Basra at 2021. Patients and methods: Sixty patients of both genders of more than 18 years from ASA I and II underwent both elective or emergency surgeries of the forearm and hand were randomly divided into 3 group L, P and K. There were 20 patients in each one. In this study, patients belonging to group L, had 40 ml of 3mg/kg of lignocaine diluted in normal saline for administering IVRA, and in patients of group P, 40 ml of 1.5mg/kg of lignocaine combined with 300mg paracetamol in group P and 0.2 mg/kg of ketamine in group K. Results: There were no difference between groups regarding ASA status. The time of onset of anesthesia was comparable in group L was 7.5±2.6 minutes, while group P was 15.3± 2.7 minutes and 15.2± 2.6 in group K . The patients in groups P and K were showing excellent muscle relaxation and excellent intraoperative and postoperative analgesia as compared to group L while group K had postoperative sedative and analgesic effects, although it was statistically not significant. Conclusion: We conclude that the addition of paracetamol to diluted lignocaine enhances lignocaine action and results in an adequate sensory and motor blockade only for short surgical procedure because reduction lignocaine dose delay onset of anesthesia and affect its duration. Despite analgesic effects of ketamine but some patients felt discomfort.