European Journal of Molecular & Clinical Medicine

Intravenous regional anaesthesia with conventional large dose of local anaesthetic is associated with serious systemic toxicity when the tourniquet deflates unexpectedly during the procedure or when it is deflated intentionally at the  end of surgery. Therefore modifications in IVRA have been done with the use of low dose of local anaesthetic to decrease systemic toxicity and addition of muscle relaxant and opioid to local anaesthetic to get the same quality analgesia as high dose local anaesthetic. Hence the present study is carried out to compare the sensory and motor characteristics, and side-effects during intra- operative and post-operative period between the patients who received 0.5% lignocaine    alone and those who received combination of 40 ml of 0.25% lignocaine with 1 mg butorphanol and 2mg atracurium in intravenous regional anaesthesia for upper limb surgeries  . AIM: 1 .  TO COMPARE THE SENSORY AND MOTOR CHARACTERISTICS IN INTRAVENOUS REGIONAL ANAESTHESIA  IN BOTH THE  GROUPS 2.  TO  COMPARE THE SYSTEMIC SIDE EFFECTS IN THE TWO GROUPS. METHOD: 60 ASA class 1 and 2 patients scheduled for elective upper limb surgeries were randomly allocated to receive IVRA either with 40ml of 0.5% lignocaine alone (Group A, n = 30) or combination of 40 ml of 0.25% lignocaine with 1 mg butorphanol and 2 mg atracurium (Group B, n = 30). The sensory and motor characteristics, cardiovascular & respiratory parameters and side effects were studied during the intra-operative and post-operative period. RESULT: The time of onset of sensory loss & motor block ,the time of complete sensory block, and the time of  complete motor block were significantly delayed in group B.  But the quality of analgesia was similar in both groups after 10-15 minutes of the injection  of  anaesthetic solution. There was no significant difference between two groups in the time of return of full motor power and full sensation There was no significant difference in cardiovascular & respiratory parameters and incidence of side  effects between the two groups. CONCLUSION: The study indicated that the triple combination of 40 ml of 0.25% lignocaine, 1mg butorphanol  and 2mg atracurium produces the same quality of analgesia as 40ml of 0.5% lignocaine in IVRA. Thus, this modified technique of intravenous regional anaesthesia allows a reduction in the dose of local anaesthetic agent thus reducing the potential toxicity of the local anaesthetic agent.

The standard technique of laryngoscopy and endotracheal intubation involves the stimulation of Larynx, Pharynx, Epipharynx and trachea, which are extensively innervated by Autonomic nervous system, namely the parasympathetic innervation via vagus and glossopharyngeal nerves and sympathetic via superior cervical ganglion. All patients were explained in detail about the study and informed consent was taken. Patients were randomly allocated to receive intravenous Magnesium sulphate infusion 30 mg/kg, 15 minutes before induction of anaesthesia or injection Lignocaine 1.5mg/kg intravenously 90 seconds before intubation. All patients had an peripheral intravenous line secured in the pre-operative holding area. Randomization was done by picking lots. The Anaesthesiologist who prepared and administered the drug was not involved with the intra and post-operative management of the patient. We conclude that Magnesium sulphate and Lignocaine are effective in blunting the hemodynamic response to intubation, but Magnesium sulphate is superior to Lignocaine in blunting the hemodynamic response to laryngoscopy and endotracheal intubation without any significant side effects.

Laryngoscopy and endotracheal intubation result in pressor and sympathoadrenal responses. Certain agents such as Lignocaine and Labetalol can be given to prevent these hemodynamic changes prior to intubation.
Materials and Methods: 60 patients of ASA grade I, scheduled for various surgeries under general anaesthesia were divided into 2 Groups. Patients in Group A were given 2% Inj. Lignocaine hydrochloride (preservative free) intravenously at 1.5mg/kg over 10 seconds, 90 seconds before laryngoscopy. Patients in Group B were administered 0.5 mg/kg Inj. Labetalol IV, 10 minutes before intubation. Laryngoscopy and endotracheal intubation were performed after induction. Heart rate, systolic, diastolic and the mean arterial blood pressure were recorded before induction, after induction, during intubation and at 1, 3 and 5 minutes post intubation.
Results: Heart rate, systolic and diastolic blood pressures and the mean arterial pressures were significantly lower in the Labetalol group when compared to the Lignocaine group, with the mean arterial pressure and the heart rate attaining the basal value in the Labetalol group after 5 minutes of intubation, while it was still higher in the Lignocaine group.
Conclusion: Labetalol is a better drug for the attenuation of the hemodynamic changes that take place during intubation compared to Lignocaine.

Background:Haemodynamic changes occurring during direct laryngoscopy and endotracheal
intubation are well tolerated by healthy individuals but can be fatal in patients with
hypertension, heart disease and intracranial hypertension. Many methods have been tried to
obtund these responses.
Methods: 60 consenting patients were randomised to receive 30 mg/kg of magnesium
sulphate (MgSO4) in 100 ml saline over 10 min before induction or preservative free 2%
lignocaine 1.5 mg/kg diluted to 5 ml with saline 90 secs before intubation. Heart rate,
systolic, diastolic & mean blood pressures and time taken to extubate were monitored.
Results: Hemodynamic parameters showed no significant rise at intubation in both the
groups. Time taken to extubate was similar in both the groups.
Conclusion: MgSO4 30 mg/kg given intravenously as infusionover 10 minutes prior to
induction and lignocaine 1.5 mg/kg given 90 seconds before intubation were comparable in
attenuating pressor response to laryngoscopy and intubation with no clinically significant
prolongation in time taken to extubate in MgSO4 group.

Background: Endotracheal intubation is a common mode of securing the airway for
administering general anaesthesia. Direct laryngoscopy and endotracheal intubation is almost
always associated with haemodynamic changes due to reflex sympathetic stimulation caused
by laryngopharyngeal stimulation.
Methods: A prospective, randomized controlled clinical study was undertaken to compare
the efficacy of oropharyngeal lignocaine spray (group L,n=30) and sublingual nitroglycerine
spray (group N, n=30) in blunting of haemodynamic response to laryngoscopy and intubation
belonging to ASA I, posted for surgery under general anaesthesia.
Results: There was statistically significant difference in the mean heart rate between the
groups for the first 3 minutes after intubation. Statistical evaluation between the groups
showed the mean SBP was statistically significant (p=0.036) for initial 3 mins after intubation
and also at 5th 6th & 10th minute. Statistical evaluation between the groups showed that
mean DBP 1st minute after intubation was statistically significant (p=0.008). The difference
was significant at 4, 5, 6 and 9 min after intubation. Statistical evaluation between the groups
did not show any statistical difference in the MAP except at 5th & 6th minute. However,
there was no clinically significant difference in any of the above groups.
Conclusion: Both sublingual NTG & lignocaine group successfully blunted the intubation
response, sublingual NTG spray was better in suppressing the BP response to laryngoscopy
and intubation than oropharyngeal lignocaine spray but lignocaine controlled the HR
response better than NTG.