Department of Anesthesia and Intensive Care, Safdarjang Hospital and Vardhman Mahavir Medical College (V.M.M.C), University of Delhi, New Delhi - 110029, India.
J Clin Anesth. 2010 Aug;22(5):324-8. doi: 10.1016/j.jclinane.2009.09.005.
To evaluate the effect of adding neostigmine to lidocaine in intravenous regional anesthesia (IVRA).
Randomized, double-blinded study.
Tertiary-care academic medical institution.
40 ASA physical status I and II patients scheduled for elective or emergency forearm and hand surgery.
Patients were randomized to two groups of 20 patients each. In the control group, IVRA was established using 40 mL of 0.5% lidocaine with one mL of isotonic saline, while neostigmine group patients received 40 mL of 0.5% lidocaine with 0.5 mg neostigmine.
Hemodynamic parameters, onset and recovery times of sensory and motor blocks, and quality of anesthesia achieved with IVRA were recorded. After tourniquet deflation, visual analog pain scores (VAS) were noted every 30 minutes in the first two hours, as were the time to first analgesic request and total analgesic requirement in the 24-hour postoperative period.
In the first 24 hours after surgery, the neostigmine group had significantly lower VAS scores, longer time to first analgesic request, and reduced total analgesic requirement. Intraoperatively, the neostigmine group had significantly shorter sensory and motor block onset times and longer recovery times than the control group. No significant frequency of adverse effects was seen in either group. The quality of intraoperative anesthesia and frequency of tourniquet pain were similar in both groups.
The addition of neostigmine to lidocaine shortens onset time and improves postoperative analgesia in IVRA for upper limb surgery.
评估在静脉局部麻醉（IVRA）中加入新斯的明对利多卡因的效果。
随机、双盲研究。
三级保健学术医疗中心。
40 名 ASA 身体状况 I 和 II 级择期或急诊前臂和手部手术患者。
患者随机分为两组，每组 20 名患者。在对照组中，使用 40 毫升 0.5%利多卡因加 1 毫升等渗盐水建立 IVRA，而新斯的明组患者接受 40 毫升 0.5%利多卡因加 0.5 毫克新斯的明。
记录血流动力学参数、感觉和运动阻滞的开始和恢复时间以及 IVRA 达到的麻醉质量。止血带放气后，在头两个小时的每 30 分钟记录视觉模拟疼痛评分（VAS），并记录术后 24 小时内首次使用镇痛药的时间和总镇痛药需求。
术后 24 小时内，新斯的明组 VAS 评分明显较低，首次使用镇痛药的时间较长，总镇痛药需求减少。术中，新斯的明组感觉和运动阻滞的起始时间明显缩短，恢复时间明显延长，而对照组则相反。两组均未出现明显的不良反应发生率。两组术中麻醉质量和止血带疼痛频率相似。
在静脉局部麻醉中加入新斯的明可缩短起效时间，并改善上肢手术的术后镇痛效果。
