Estèbe Jean-Pierre, Gentili Marc E, Langlois Grégoire, Mouilleron Philippe, Bernard Franck, Ecoffey Claude
Department of Anesthesia Intensive Care and Pain Clinic,, University Hospital of Rennes, France.
Reg Anesth Pain Med. 2003 Mar-Apr;28(2):120-3. doi: 10.1053/rapm.2003.50123.
Tourniquet pain often limits the use of intravenous regional anesthesia (IVRA). Intravenous (IV) lidocaine has been shown to be effective in the management of acute and neuropathic pains. We tested the hypothesis that a priming IV injection of lidocaine might have an analgesic effect on tourniquet pain during IVRA.
A prospective, randomized, double- blind study was conducted on 40 patients scheduled for carpal tunnel decompression. No sedation was given. Each patient received either 1 mg/kg of IV lidocaine (group L) or 0.1 mL/kg of IV isotonic saline (group control = C) 5 minutes before IVRA. Thereafter, they received 3 mg/kg of plain 0.5 % lidocaine into the isolated and exsanguinated arm. A double-cuffed tourniquet was used. Pain at the tourniquet and the surgical sites was assessed every 5 minutes using a linear visual analog scale (VAS) and a verbal rating scale (VRS) during the surgical procedure and the immediate postoperative period (60 minutes).
Demographic data and duration of proximal and distal tourniquet were similar in each group. Significant differences in the pain scales were observed for the distal tourniquet at tourniquet inflation time and 15 minutes after (P =.03 and.005, respectively) in the group L. For the proximal tourniquet, only the VRS was significantly improved (P =.03). No analgesic benefit was observed in the immediate postoperative period.
Priming IV lidocaine when compared with isotonic saline is effective in reducing tourniquet pain in IVRA.
止血带疼痛常常限制静脉区域麻醉（IVRA）的应用。静脉注射利多卡因已被证明在治疗急性疼痛和神经性疼痛方面有效。我们检验了一个假设，即在静脉区域麻醉期间，静脉注射利多卡因预充可能对止血带疼痛具有镇痛作用。
对40例计划行腕管减压术的患者进行了一项前瞻性、随机、双盲研究。未给予镇静剂。在进行静脉区域麻醉前5分钟，每位患者接受1mg/kg静脉注射利多卡因（L组）或0.1mL/kg静脉注射等渗盐水（对照组 = C组）。此后，他们在已隔离并驱血的手臂中接受3mg/kg的普通0.5%利多卡因。使用双袖带止血带。在手术过程中和术后即刻（60分钟），每隔5分钟使用线性视觉模拟量表（VAS）和语言评定量表（VRS）评估止血带部位和手术部位的疼痛。
每组的人口统计学数据以及近端和远端止血带使用时间相似。在L组中，在止血带充气时和充气后15分钟，远端止血带的疼痛量表存在显著差异（分别为P = 0.03和0.005）。对于近端止血带，仅语言评定量表有显著改善（P = 0.03）。在术后即刻未观察到镇痛效果。
与等渗盐水相比，静脉注射利多卡因预充在减轻静脉区域麻醉中的止血带疼痛方面有效。
