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Clinical Study Comparison of the Effect of Lidocaine Adding Dexketoprofenand Paracetamol in Intravenous Regional Anesthesia

Ali Akdogan and Ahmet Eroglu

Anesthesiology and Intensive Care Medicine, Karadeniz echnical University, rabzon, urkey

Correspondence should be addressed to Ali Akdogan; [email protected]

Received December ; Accepted February ; Published March Academic Editor: Engin Erturk

Copyright A. Akdogan and A. Eroglu. Tis is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective. Comparison o dexketopro en and paracetamol added to the lidocaine in Regional Intravenous Anesthesia in termso hemodynamic effects, motor and sensorial block onset times, intraoperative VAS values, and analgesia requirements. Method.Te les o patients between and years old in the ASA I-II risk group who underwent hand and orearm surgery wereanalyzed and patients were included in the study. Patients were divided into groups: Group D ( = 20), mg/kg % lidocaineand mg/ mL dexketopro en trometamol; Group P ( = 20), mg/kg % lidocaine and mg/kg paracetamol; Group K ( =20), mg/kg % lidocaine. Demographic data, motor and sensorial block times, heart rate, mean blood pressure, VAS values, andintraoperative andpostoperative analgesiarequirementswere recorded. Results.Sensorial andmotorblockonsetdurations o Group

K were signi cantly longer than other groups. Motor block termination duration was ound to be signi cantly longer in Group Dthan in Group K. VAS values o Group K were ound higher than other groups. Tere was no signi cant difference in VAS valuesbetween Group D and Group P. Analgesia requirement was ound to be signi cantly more in Group K than in Group P. Tere wasno signi cant difference between the groups in terms o heart rates and mean arterial pressures. Conclusion. We concluded that theaddition o mg/kg paracetamol and mg dexketopro en to lidocaine as adjuvant in Regional Intravenous Anesthesia applied orhand and/or orearm surgery created a signi cant difference clinically.

1. Introduction

Regional Intravenous Anesthesia (RIVA) was rst appliedby German surgeon, August K.G. Bier, in , and thistechnique was de ned as Bier block [ ]. RIVA is generally pre erred or patients who will have upper extremity surgery due to advantages such as providing a blood ree surgery site, rapid onset and termination o the anesthetic effect, lack o necessity o severe sedation, and general anesthesia andeasy application [ , ]. Ketorolac, tenoxicam, paracetamol,clonidine, myorelaxant drugs, and opioids were added intolocal anesthetic agents as adjuvant to increase block quality in RIVA, to reduce tourniquet pain, to provide postoperativeanalgesia, and to reduce the dose o local anesthetic agentadministrated [ ].

Although molecular mechanism is not known well,intravenous paracetamol (per algan) is used or mild andintermediate postoperative pain. It is a nonopioid analgesicwhich reduces theopioidquantity used orsevere pain [ ].

Dexketopro en trometamol is a nonselective NSAII withanalgesic, antipyretic, and anti-in ammatory characteristicso which the parenteral orm was developed in [].

In the present study, we aimed to compare sensorialblock onset andreturn periods, motor block onset andreturnperiods, the block quality that appeared, preoperative andpostoperative vital signs, and the need or intraoperative andpostoperative analgesia or lidocaine-paracetamol combina-tion and lidocaine-dexketopro en combination retrospec-tively in the light o ndings that we have obtained by theexamination o patient les who haveundergonehand and/or

orearm surgery through the RIVA method in our university.

2. Material and Method

Records o adult patients re erred to Karadeniz echnicalUniversity, Faculty o Medicine, Orthopedics Clinic and whohave undergone hand and orearm surgery were enrolled.

Hindawi Publishing CorporationBioMed Research InternationalVolume 2014, Article ID 938108, 5 pageshttp://dx.doi.org/10.1155/2014/938108
http://dx.doi.org/10.1155/2014/938108http://dx.doi.org/10.1155/2014/938108


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BioMed Research International

Once the study protocol was approved by the ethics com-mittee o the Karadeniz echnical University in accordancewith the nd Helsinki Declaration (date: . . , meetingno.: / , resolution no.: ), theanesthesia records o thepatients were selected and the patients were enrolled in thestudy. Adult patients who have been examined routinely by

anamnesis and physical examination and classi ed as ASA Iand II according to preoperative physical status classi cationrecommended by the American Society o Anesthetists wereincludedin the study. Anesthesia recordsandhospital archiverecords o patients between the age o and to whomregional intravenous anesthesia (RIVA) was applied wereexamined. Te data o patients were not included in thestudybecause theydid notcomply with thestudycriteria, andthe data o patients were examined.

Exclusioncriteria were (i) analgesicdrug treatment in theprevious h, (ii) history o allergy to study medications, (iii)any neurological de cit in the upper extremities, and (iv) thepresence o any contraindications to IVRA.

Age, gender, ASA, operation duration, and tourniquetperiods were recorded rom hospital archive les and anes-thesia records.

It was observed rom the les that premedicationby . mg/kg midazolam (im) was per ormed be ore thesurgery and RIVA (Regional Intravenous Anesthesia) wasapplied by monitoring average arterial pressure, heart rate,and peripheral oxygen saturation parameters.

Te patients were divided into the ollowing groupsaccording to the medications used or RIVA procedure.

Groups

( ) (Group D) lidocaine-dexketopro en group: patients

( = 20) on whom RIVA was per ormed by the addi-tion o mg/kg % lidocaine and mg/ mL dexke-topro en trometamol (Arveles mg/ mL; UFSAPharmaceuticals, opkap/Istanbul, urkey) dilutedwith . % normal saline to a total volume o mL.

( ) (Group P) lidocaine-paracetamolgroup: patients ( =20) on whom RIVA was per ormed by the addition o

mg/kg % lidocaine and mg/kg paracetamol (Per-algan mg/ mL vial, Bristol-Myers Squibb,

France) diluted with . % normal saline to a total volume o mL.

( ) (Group K) lidocaine-control group: patients ( =20) on whom RIVA was per ormed by mg/kg %lidocaine diluted with . % normal saline to a total volume o mL.

Records o these patients in three groups were examined.It was observed that the tourniquet pressure o the

RIVA solution was kept as to mmHg higher thansystolic arterial pressure or at to mmHg, study medications were administrated within seconds, sensorialblock was assessed by a pinprick test every seconds,sensorial examination o antebrachial, radial, ulnar, andmedian nerve dermatomes was conducted, and the motorblock was assessed via the Modi ed Bromage Scale (MBS) by inability to move the wrist and ngers voluntarily by asking

the patients i they could move their wrist and ngers. It wasalso observed that sensorial and motor block onset times andtermination times o theblockswere recordedand their meanarterial pressures (MAP), heart rates, pulse oximeter, andoxygen saturations (spO ) were recorded and their recordswere evaluated.

It was detected that VAS (Visual Analog Scale) andRamsey sedation scale were used be ore and at the th,th, th, and th minutes afer tourniquet procedure and

at the th, th, th, and th minutes and the st andnd hours afer the tourniquet was opened or pain and

sedation level measurements. Furthermore, intraoperativeandpostoperative analgesic requirementso the patients whohad analgesic administration as entanyl g/kg when intra-operative VAS was over were examined. It was observedthat mg oral Parol tablet was given to the patientswhose pain sustained postoperatively and mg contramaltablet or those whose pain was persistent. It was detectedthat interviews were per ormed with the patients afer their

dischargeand questionsrelated to operation com ort, quality,and incision pain were asked. Side effects that the patientshad, such as nausea, vomiting, dyspeptic complaints, skinrash, and tinnitus, were examined rom hospital archive lesand anesthesia records.

Statistical data analysis was carried out by using Sta-tistical Package or Social Sciences (SPSS) or WindowsRelease . program. Ki-Square was used or comparison o qualitative data; compliance to normal distribution in com-parison o the data obtained by measurement was per ormedthrough the Kolmogorov-Smirnov test; students -test wasused i it complied with the normal distribution and theMann-Whitney -test was used i it did not comply. Variance

analysis o repetitive measurements or the Friedman test wasused or comparison o measurements which continue romthe beginning. Data obtained through measurements wereexpressed with mean standard deviation and data obtainedby count was expressed as %. Signi cance level was acceptedas < 0.05.

3. Results

No difference was detected between the groups in termso age, gender, ASA, operation durations, and tourniquetperiods ( able ).

Nosigni cant differencewas ound between thegroupsin

terms o intraoperative and postoperative time values, heartrates, and mean arterial pressure values.Tere was no statistically signi cant between-group type

o surgery ( able ).Sensorial block onset durations o Group K were sig-

ni cantly longer than other groups ( < 0.05 ). Tere wasno signi cant difference between Groups D and P in termso sensorial block onset periods. No signi cant differenceexisted between the groups in terms o sensorial block termination times as well ( able ).

Motor block onset durations o Group K were signi -icantly longer than other groups ( < 0.05). Tere wasno signi cant difference between Groups D and P in terms


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: Demographic data, total operation time and total tourniquet, and application time (mean SD).

Group K control( = 20)

Group D dexketopro en( = 20)

Group P paracetamol( = 20)

Age (year) . 1 . .5 1 . .5 1 .Sex-male (% ) (% ) (% )

Sex- emale (% ) (% ) (% )ASA- (% ) (% ) (% )ASA- (% ) (% ) (% )Operation time (min) .0 8. .0 9. .5 1 .ourniquet time (min) .3 9. .5 1 . .5 1 .

ASA. American Society o Anesthesiologists physical classi cation status.

: ypes o operations per ormed.

ype o surgery Group K Control( = 20)



rigger nger

Carpal tunnel syndrome endon release

Cyst excision

: Block onset times and block regression times o the groups (mean SD).

Group K control( = 20)



Sensory block onset time (min) . 0 1. . 6 1. .6 1 .Sensory block regression time (min) . 0 1. .1 1. .9 1.Motor block onset time (min) . 0 4. . 5 2. .5 2.Motor block regression time (min) . 0 2. .5 1. . 0 3. < 0.05 according to Group D and Group P.

o sensorial block onset periods. Motor block terminationduration was ound signi cantly longer in Group D thanGroup K ( < 0.05 ) ( able ).

VAS values o Group K were higher than other groups( < 0.05 ). Tere was no signi cant difference in VAS valuesbetween Group D and Group P ( Figure ).

Intraoperative analgesia requirements were signi cantly more in Group K than Group P and Group D. Intraoperativeanalgesia was required or patients in Group K and or patients in Group D. Postoperative analgesia requirementswere signi cantly more in Group K than Group P and GroupD. Postoperative analgesia was required or patients inGroup K and or patients in Group D (Figure ).

It was also ound that patient had skin rash and patients had bradycardia during their ollow-ups. Tere wasno signi cant difference between the groups ( > 0.05 ).

4. Discussion

Regional intravenous anesthesia is a common regional anes-thesia method used or upper extremity surgery. It wasdetected that the addition o mg/kg paracetamol and mgdexketopro en into local anesthetic agents as adjuvant in

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3VAS

Group DGroup PGroup K

P < 0.05 according to Group K

P r e o p

T o r q u e

i n

a t i o n

S u r g e r y s t a r

t

5 m

i n

1 0 m

i n

3 0 m

i n

1 5 m

i n

T o r q u e r e

l e a s e

5 m

i n

1 0 m

i n

1 5 m

i n

3 0 m

i n 1

h 2

h

F : Intraoperative and postoperative visual analogue scale(VAS) scores ( ).

regional intravenous anesthesia per ormed or hand and/ororearm surgery reduced VAS values and shortened sensorial

block onset time and motor block return time signi cantly


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whom mgo dexketopro en and mg/kg paracetamolwereadded to mg/kg in regional intravenous anesthesia.

According to our results, the addition o mg dexketo-pro en and mg/kg paracetamol to mg/kg lidocaine short-ened sensorial and motor block onset periods and prolongedmotor block and sensorial block termination periods when

compared with the patients to whom adjuvant was notadded in line with the studies conducted. Furthermore, itwas ound that it reduced intraoperative analgesia need andintraoperative and postoperative VAS values were lower; nosigni cant difference existed in hemodynamicparameters. Inthe study conducted, no signi cant value was ound whengroups that adjuvant was added to were compared.

Consequently, it was ound that the addition o parac-etamol and dexketopro en to the lidocaine in regional intravenous anesthesia applied or hand and/or orearm surgery does not create any signi cant difference; however, it is moresuccess ul clinically according to the group without adjuvantaddition.

Conflict of Interests

Te authors declare that there is no con ict o interestsregarding the publication o this paper.

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