Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia
Citation Information :
Solanki D, Singh M. Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia. J Recent Adv Pain 2018; 4 (1):19-24.
Objective
Intravenous regional anesthesia (IVRA) is used for short procedures for hand and upper limb surgeries. In terms of analgesia duration and quality of anesthesia, IVRA with adjuvants like opioids, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs) increases the efficacy. We conducted this comparative study for evaluating the effect of adding magnesium sulfate and clonidine with lignocaine in IVRA for upper limb surgeries.
Materials and methods
Seventy-five patients with American Society of Anesthesiologists (ASA) class I and II of either sex, age 18 to 60 years, undergoing upper limbs surgeries were enrolled. They were divided into three groups (25 each) according to drug received. Group L: 9 mL of 2% lignocaine (preservative-free) diluted with normal saline to make a total volume of 36 mL of 0.5% lignocaine. Group M: 3 mL of 50% magnesium sulfate with 9 mL of 2% lignocaine diluted with normal saline to make total volume of 36 mL, 0.5% lignocaine. Group C: 1 µg/kg clonidine with 9 mL of 2% lignocaine diluted with normal saline to make total volume of 36 mL of 0.5% lignocaine. Sensory and motor block (onset and recovery time), intraoperative tourniquet pain, first tramadol requirement time and mean tramadol dosage, quality of operative conditions, hemodynamic parameters, postoperative pain scores [in visual analog scale (VAS)] were recorded.
Results
Both groups were comparable in terms of age, sex, ASA grade, baseline hemodynamic parameters, duration of surgery, and tourniquet inflation time. Shortened sensory and motor block onset times were established in M group (p < 0.05). Recovery from sensory and motor blockade was significantly prolonged in M group (p < 0.05). Anesthesia excellence as determined by anesthesiologist and surgeon was significantly better in C group as compared with rest of the two groups (p < 0.05). There was statistically significant difference (p > 0.05) in intraoperative VAS scores in groups M and C as compared with group L, throughout the procedure. Time to first analgesic requirement in group C was 43.04 ± 27.46 minutes, group M 42.72 ± 18.06 minutes, and group L was 27.08 ± 4.45 minutes (p < 0.05). Postoperative VAS scores for 24 hours were higher in group L as compared with groups M and C (p < 0.05).
Conclusion
Magnesium sulfate as an adjuvant to lignocaine hydrochloride for IVRA for upper limb surgeries shortens the onset of sensory and motor block to a greater extent as compared with clonidine and lignocaine alone, though postoperative analgesia was found to be of longer duration with clonidine as an adjuvant.
How to cite this article
Solanki D, Singh M. Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia. J Recent Adv Pain 2018;4(1):19-24.
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