International Journal of Anesthesia and Clinical Medicine

| Peer-Reviewed |

Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain

Received: 07 March 2016    Accepted: 25 April 2016    Published: 08 June 2016
Views:       Downloads:

Share This Article

Abstract

Background and purpose: The main and the most known complication of intravenous regional anesthesia (IVRA) is systemic toxicity due to local anesthetics that occurs following the accidental tourniquet release immediately after injection. This study aims to evaluate the effect of adding ketamine to lower dose of lidocaine on reducing the dose and side effects of lidocaine. Materials and Methods: In this randomized clinical trial, 60 patients undergoing the surgery of upper limb below the elbow under IVRA were randomly divided into two groups. In group 1 (control group), 40 ml lidocaine 0.5% (200 mg) and in group 2 (intervention group), 40 ml lidocaine 0.25% (100 mg) plus 40 mg of ketamine 0.1% injected intravenously. Outcomes included postoperative pain at 15, 30 and 60 minutes after surgery. The pain of the patients was assessed by using the Visual Analogue Scale (VAS Score). Results: Both groups were comparable in demographic and surgical parameters. The average pain based on the VAS score at 15, 30 and 60 minutes after surgery was similar in both groups and there was no significant difference between the two groups (p> 0.05). Moreover, postoperative complications including unconsciousness, restlessness, dizziness, nausea, vomiting, tinnitus, seizure, delirium and hallucination had no significant differences (p> 0.05). Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects.

DOI 10.11648/j.ja.20160401.11
Published in International Journal of Anesthesia and Clinical Medicine (Volume 4, Issue 1, January 2016)
Page(s) 1-4
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Regional Anesthesia, Analgesic Effect, Lidocaine, Ketamine

References
[1] Wedel DJ, Hor Locker TT. Nerve block. In: Miller RD, editors. Miller’s Anesthesia. 7th ed. Philadelphia Churchill Livingstone; 2010. 1648-9.
[2] Charls B, Berde & Gary R. Strichartz, Local anesthetics. In: Miller RD, editors. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. 2436.
[3] Brown EM, Mc Griff, Malinowski RW. Intravenous regional anesthesia (Bier block): Review of 20 years experience. Can J Anaesth. 1989; 36: 307-310.
[4] Johnson CN. Intravenous regional anesthesia: new approaches to an old technique. CRNA. 2000; 11: 57-61
[5] Tverskoy M, Oren M, Vaskovich M, et al. Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanism: A study in postoperative patients. Neurosci Lett 1996; 215: 5- 8.
[6] Carlton SM, Hargett Gl, Coggeshall RE. Localization and activation of glutamate receptors in unmyelinated axons of rat glabrous skin. Neurosci Lett 1995; 197: 25- 8.
[7] Pedersen JL, Galle TS, Kehlet H. Peripheral analgesic effects of ketamine in acute inflammatory pain. Anesthesiology 1998; 89: 58-66.
[8] Marcia L., Buck, Pharm. D. Use of lidocaine for analgesia in children and adolescents. Pediatr Pharm. 2013; 19 (12).
[9] Flamer D, Peng PW. Intravenous regional anesthesia: a review of common local anesthetic options and the use of opioids and muscle relaxants as adjuncts. Local Reg Anesth. 2011; 4: 57-76.
[10] Gorgias NK, Maidatsi PG, Kyriakidis AM, et al. Clonidine versus ketamine to prevent tourniquet pain during intravenous regional anesthesia with lidocaine. Regional Anesthesia and Pain Medicine 2001 Nov- Dec; 26 (6): 512-7.
[11] Annetta MG, Iemma D, Garisto C, Tafani C, Proietti R. Ketamine: new indications for an old drug. Curr Drug Targets. 2005; 6: 789-794.
[12] Gunduz M, Ozalevli M, Ozbek H, Ozcengiz D. Comparison of caudal ketamine with administration for postoperative analgesia of hypospadias surgery in children. Pediatric Anesthesia 2006; 16: 158-63.
[13] Durrani Z, Winnie AP, Zsigmond EK, et al. Ketamine for intravenous regional anesthesia. Anesthesia & Analgesia 1989; 68: 328-32.
[14] Attal N, Rouaud J, Brasseur L, Chauvin M, Bouhassira D. Systemic lidocaine in pain due to peripheral nerve injury and predictors of response. Neurology. 2004 Jan 27; 62 (2): 218-25.
[15] Sen S, Ugur B, Aydın ON, Ogurlu M, Gursoy F, Savk O. The analgesic effect of nitroglycerin added to lidocaine on intravenous regional anesthesia. Anesth Analg 2006; 102: 916-20.
[16] Reves JG, Class PS, Lubarsky DA, et al. Intravenous anesthetics. Miller RD, editors. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. 747-92.
[17] Flood P. Personalized intravenous regional anesthesia. Saudi J Anaesth. 2010; 4: 46.
[18] Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium: part I. Anesth Analg. 2001; 92: 1173-1181.
[19] Hala S. Abdel-Ghaffar, MD, Mahmoud Abdel-Azez Kalefa, PhD, Ahmed Said Imbaby, MBBCH. Efficacy of ketamine as an adjunct to lidocaine in intravenous regional anesthesia. Regional Anesthesia and Pain Medicine. 2014; 39: 418-422.
[20] Rahimi M, Saghaei M, Heidari M., Intravenous regional anesthesia using lidocaine and ketamine.ٍ EJA 2006; 23: 127-129.
[21] Alok Kumar, DK Sharma, Barun Datta. Addition of ketamine or dexmedetomedian to lingocaine in intravenous regional anesthesia: A randomized controlled study. Journal of Anaesthesiology Clinical Pharmacology 2012; 28 (4): 501-4.
[22] Baad-Hansen, L., Juhl, GI., Jensen, TS., Brandsborg, B., & Svensson, P. Differential effect of intravenous S-ketamine and fentanyl on atypical odontalgia and capsaicin-evoked pain, Pain, 2007; 129 (1-2): 46-54
[23] Amr, YM. Multi-Day Low Dose Ketamine Infusion as Adjuvant to Oral Gabapentin in Spinal Cord Injury Related Chronic Pain: A Prospective, Randomized, Double Blind Trial, Pain Physician, 2010; 13: 245-49.
Author Information
  • Department of Anesthesiology, Medical Faculty, Qazvin University of Medical Sciences, Qazvin, Iran

  • Department of Anesthesiology, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran

  • Department of Community Medicine, Medical Faculty, Zanjan University of Medical Sciences, Zanjan, Iran

Cite This Article
  • APA Style

    Siamak Yaghubi, Vahideh Rashtchi, Farzaneh Karamitanha. (2016). Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain. International Journal of Anesthesia and Clinical Medicine, 4(1), 1-4. https://doi.org/10.11648/j.ja.20160401.11

    Copy | Download

    ACS Style

    Siamak Yaghubi; Vahideh Rashtchi; Farzaneh Karamitanha. Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain. Int. J. Anesth. Clin. Med. 2016, 4(1), 1-4. doi: 10.11648/j.ja.20160401.11

    Copy | Download

    AMA Style

    Siamak Yaghubi, Vahideh Rashtchi, Farzaneh Karamitanha. Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain. Int J Anesth Clin Med. 2016;4(1):1-4. doi: 10.11648/j.ja.20160401.11

    Copy | Download

  • @article{10.11648/j.ja.20160401.11,
      author = {Siamak Yaghubi and Vahideh Rashtchi and Farzaneh Karamitanha},
      title = {Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {4},
      number = {1},
      pages = {1-4},
      doi = {10.11648/j.ja.20160401.11},
      url = {https://doi.org/10.11648/j.ja.20160401.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ja.20160401.11},
      abstract = {Background and purpose: The main and the most known complication of intravenous regional anesthesia (IVRA) is systemic toxicity due to local anesthetics that occurs following the accidental tourniquet release immediately after injection. This study aims to evaluate the effect of adding ketamine to lower dose of lidocaine on reducing the dose and side effects of lidocaine. Materials and Methods: In this randomized clinical trial, 60 patients undergoing the surgery of upper limb below the elbow under IVRA were randomly divided into two groups. In group 1 (control group), 40 ml lidocaine 0.5% (200 mg) and in group 2 (intervention group), 40 ml lidocaine 0.25% (100 mg) plus 40 mg of ketamine 0.1% injected intravenously. Outcomes included postoperative pain at 15, 30 and 60 minutes after surgery. The pain of the patients was assessed by using the Visual Analogue Scale (VAS Score). Results: Both groups were comparable in demographic and surgical parameters. The average pain based on the VAS score at 15, 30 and 60 minutes after surgery was similar in both groups and there was no significant difference between the two groups (p> 0.05). Moreover, postoperative complications including unconsciousness, restlessness, dizziness, nausea, vomiting, tinnitus, seizure, delirium and hallucination had no significant differences (p> 0.05). Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects.},
     year = {2016}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Comparing the Analgesic Effects of Lidocaine and Lidocaine with Ketamine in Intravenous Regional Anesthesia on Postoperative Pain
    AU  - Siamak Yaghubi
    AU  - Vahideh Rashtchi
    AU  - Farzaneh Karamitanha
    Y1  - 2016/06/08
    PY  - 2016
    N1  - https://doi.org/10.11648/j.ja.20160401.11
    DO  - 10.11648/j.ja.20160401.11
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 1
    EP  - 4
    PB  - Science Publishing Group
    UR  - https://doi.org/10.11648/j.ja.20160401.11
    AB  - Background and purpose: The main and the most known complication of intravenous regional anesthesia (IVRA) is systemic toxicity due to local anesthetics that occurs following the accidental tourniquet release immediately after injection. This study aims to evaluate the effect of adding ketamine to lower dose of lidocaine on reducing the dose and side effects of lidocaine. Materials and Methods: In this randomized clinical trial, 60 patients undergoing the surgery of upper limb below the elbow under IVRA were randomly divided into two groups. In group 1 (control group), 40 ml lidocaine 0.5% (200 mg) and in group 2 (intervention group), 40 ml lidocaine 0.25% (100 mg) plus 40 mg of ketamine 0.1% injected intravenously. Outcomes included postoperative pain at 15, 30 and 60 minutes after surgery. The pain of the patients was assessed by using the Visual Analogue Scale (VAS Score). Results: Both groups were comparable in demographic and surgical parameters. The average pain based on the VAS score at 15, 30 and 60 minutes after surgery was similar in both groups and there was no significant difference between the two groups (p> 0.05). Moreover, postoperative complications including unconsciousness, restlessness, dizziness, nausea, vomiting, tinnitus, seizure, delirium and hallucination had no significant differences (p> 0.05). Conclusion: Results of this study showed that the addition of ketamine to lower dose of lidocaine in patients receiving IVRA significantly reduced postoperative pain, and reduces the likelihood of systemic toxicity with lidocaine without causing significant adverse effects.
    VL  - 4
    IS  - 1
    ER  - 

    Copy | Download

  • Sections