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.

Background: Intravenous regional anaesthaesia(IVRA), also known as Biers Block is a
technique of producing surgical anaesthesia by intravenous injection of a local
anesthetic into a limb whose circulation has been interrupted by a
tourniquet.Ropivacaine is a safer alternative among available local anaesthetics with
analgesic duration 4-8 hrs. Dexamethasone is a long-acting synthetic corticosteroid and
is beneficial anti-inflammatory agent for the management of acute surgical pain.This
study was done with the aim to comparethe effectiveness as well the onset and duration
of sensory block, motor block and analgesia between ropivacaine alone and ropivacainedexamethasone
in regional anaesthesia.
Methods: 50 adult patients of ASA grade I & II in the age group of 20-50 years were
randomized into two groups of 25 patients, scheduled for ambulatory hand surgery
andwere administered intravenous( IV)Ropivacaine (0.2%) 40 ml and IV
Ropivacaine(0.2%)40ml plus 8mg Dexamethasone after inflating the proximal cuff of
tourniquet and assessment was done with pin prick and visual analogue scale
(VAS)score.
Results:This study showed, the duration as well as the recovery of sensory block was
prolonged on adding dexamethasone. In group receiving dexamethasone as an adjuvant
to ropivacaine the duration of analgesia was prolongedas well as the total analgesic
consumption was reduced. Conclusion: IVRA is a safer technique and addition of
dexamethasone to ropivacaine increases the analgesic efficacy as well the duration of
sensory block which decreases pain scores and attributes to early recovery as well as
short hospital stay.