Sen Selda, Ugur Bakiye, Aydin Osman N, Ogurlu Mustafa, Gursoy Feray, Savk Oner
Department of Anesthesiology and Reanimation, Department of Orthopedics, and Traumatology Adnan Menderes University, Medical Faculty, Aydin, Turkey.
Anesth Analg. 2006 Mar;102(3):916-20. doi: 10.1213/01.ane.0000195581.74190.48.
We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 mug NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 +/- 1.1 versus 4.5 +/- 1.2 min; P = 0.01 and 3.3 +/- 1.6 versus 5.2 +/- 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 +/- 1.6 versus 3.1 +/- 1.2 min P < 0.0001 and 7.3 +/- 1.3 versus 3.6 +/- 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 +/- 74 min versus 39 +/- 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.
我们评估了在静脉区域麻醉中，将硝酸甘油（NTG）添加到利多卡因中时的镇痛效果。30例接受手部手术的患者被随机分为两组。对照组（C组，n = 15）接受用生理盐水稀释的3mg/kg利多卡因共40mL，NTG组（NTG组，n = 15）额外接受200μg NTG。记录术中血流动力学变量、止血带充气前及充气后1、5、10、20和30分钟测量的止血带疼痛以及镇痛需求。止血带放气后，在1和30分钟以及2和4小时，记录视觉模拟评分（VAS）、首次需要镇痛的时间、术后24小时内的总镇痛消耗量以及副作用。NTG组感觉和运动阻滞起效时间缩短（分别为3.2±1.1分钟对4.5±1.2分钟；P = 0.01和3.3±1.6分钟对5.2±1.8分钟；P = 0.009），感觉和运动阻滞恢复时间延长（NTG组和C组分别为6.8±1.6分钟对3.1±1.2分钟，P < 0.0001和7.3±1.3分钟对3.6±0.8分钟，P < 0.0001），止血带疼痛的VAS评分缩短（P = 0.023），且NTG组麻醉质量改善（P < 0.05）。止血带松开后及术后NTG组的VAS评分更低（P = 0.001）。NTG组首次需要镇痛的时间比C组长（225±74分钟对39±33分钟）（P < 0.0001）。NTG组术后镇痛需求显著更小（P < 0.0001），但两组副作用相似。我们得出结论，在静脉区域麻醉中，将NTG添加到利多卡因中可改善感觉和运动阻滞、止血带疼痛及术后镇痛，且无副作用。
