Sertoz Nezih, Kocaoglu Nazan, Ayanoğlu Hilmi Ö
MD; Ege University, School of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey.
MD; Kırşehir State Hospital. Department of Anesthesiology and Reanimation, Izmir, Turkey.
Braz J Anesthesiol. 2013 Jul-Aug;63(4):311-6. doi: 10.1016/j.bjane.2012.07.001. Epub 2013 Aug 13.
In this study, our goal was to compare intraoperative and postoperative analgesic effects of lornoxicam and fentanyl when added to lidocaine Intravenous Regional Anesthesia (IVRA) in a group of outpatients who underwent hand surgery.
This is a double blind randomized study. A total of 45 patients were included, randomized into three groups. Patients in Group I (L) received 3mg.kg(-1) of 2% lidocaine 40 mL; patients in Group II (LL) received 3mg.kg(-1) lidocaine 38 mL + 2 mL lornoxicam; patients in Group III (LF) received 3mg.kg(-1) lidocaine 38 mL + 2 mL fentanyl. Our primary outcome was first analgesic requirement time at postoperative period.
Lornoxicam added to lidocaine IVRA increased the sensory block recovery time without increasing side effects and increased first analgesic requirement time at the postoperative period when compared to lidocaine IVRA (p < 0.001, p < 0.001 respectively) and fentanyl added to lidocaine IVRA (p < 0.001, p < 0.001 respectively). In addition, we also found that fentanyl decreased tourniquet pain (p < 0.01) when compared to lidocaine but showed similar analgesic effect with lornoxicam (p > 0.05) although VAS scores related to tourniquet pain were lower in fentanyl group. Lornoxicam added to lidocaine IVRA was not superior to lidocaine IVRA in decreasing tourniquet pain.
Addition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use.
在本研究中，我们的目标是比较氯诺昔康和芬太尼添加到利多卡因静脉区域麻醉（IVRA）中时，对一组接受手部手术的门诊患者的术中及术后镇痛效果。
这是一项双盲随机研究。共纳入45例患者，随机分为三组。第一组（L组）患者接受40 mL 2%利多卡因，剂量为3mg·kg⁻¹；第二组（LL组）患者接受38 mL利多卡因+2 mL氯诺昔康，剂量为3mg·kg⁻¹；第三组（LF组）患者接受38 mL利多卡因+2 mL芬太尼，剂量为3mg·kg⁻¹。我们的主要结局是术后首次镇痛需求时间。
与利多卡因IVRA相比（分别为p<0.001，p<0.001）以及与添加芬太尼的利多卡因IVRA相比（分别为p<0.001，p<0.001），添加氯诺昔康的利多卡因IVRA增加了感觉阻滞恢复时间但未增加副作用，且增加了术后首次镇痛需求时间。此外，我们还发现，与利多卡因相比，芬太尼可减轻止血带疼痛（p<0.01），尽管芬太尼组与止血带疼痛相关的视觉模拟评分（VAS）较低，但与氯诺昔康的镇痛效果相似（p>0.05）。添加氯诺昔康的利多卡因IVRA在减轻止血带疼痛方面并不优于利多卡因IVRA。
在减轻止血带疼痛方面，添加芬太尼的利多卡因IVRA似乎优于利多卡因IVRA组和添加氯诺昔康的利多卡因IVRA组，但代价是增加了副作用。然而，氯诺昔康在提供术中和术后镇痛的同时并未增加副作用。因此，氯诺昔康可能更适合临床使用。
