Background and purpose: LIDOCAINE is an intennediate acting local anesthetic agents used very much in epidural ariesthesia and has less risk of cardiac or CNS problems compared with bupivacaine. This study evaluated the duration of motor and sensory block of epidural anesthesia with LIDOCAINE alone, lidocoine plus epinephrine and LIDOCAINE plus fentanyl.Materials and Methods: In this double blind study 60 ASA I and 11 patients that scheduled for elective orthopedic operation were classified by block randomization in to three groups. Epidural anesthesia had been prescribed with 380 mg 2% LIDOCAINE plus lml nonnal saline 0.9% for group N, 380 mg 2% LIDOCAINE plus 100 m/g (lml from 1/10000 solution) for group E and 380 mg 2% LIDOCAINE plus 500 pig fentanyl for group F. The onset of sensory block and duration of motor and sensory block were recorded.Results: The mean onset time of sensory block in three groups were the same and about 8-9 minutes. The duration of complete motor block in group E (46.5 min) and F (45.3 min) were significantly higher than group N (22.5 min). The duration of sensory block in group E (117 min) was higher than group Nand F (102 min). Hypotension happened in 40%, 50% and 60% of cases and bradycardia in 10%, 25% and 30% of cases of groups N, E and F respectively.Conclusion: The results of this study showed that there were no effects on onset time of epidural sensory block with epinephrine or fentanyl as an additive to LIDOCAINE 2% but they have glittery direct effects on the duration of motor block. However, epinephrine can increase the duration of sensory block with LIDOCAINE in epidural anesthesia.We suggest that in cases that relaxation and complete motor block is needed in epidural anesthesia epinephrine or fentanyl be added to LIDOCAINE.

BACKGROUND AND OBJECTIVE: Intravenous regional anesthesia (IVRA) is a simple and reliable method for upper extremity injuries. Different additives have been combined with local anesthetics to improve block quality, decrease tourniquet pain and postoperative analgesia in IVRA. This study was performed to evaluate the effect of nitroglycerine on tourniquet pain and intraoperative analgesia when added to LIDOCAINE for IV regional anesthesia.METHODS: In a clinical trial, 50 patients with upper extremity injury were scheduled for IVRA, randomly allocated into two groups. They were unified by age and gender. Under identical condition, control group received a total dose of 200 mg LIDOCAINE diluted with saline (40 cc) and study group received 200 mg LIDOCAINE plus 200 mg nitroglycerine diluted with saline (40 cc). Anesthesia quality, tourniquet pain and opioid requirement were measured during surgery. After the tourniquet deflation, time to first analgesic requirement was noted.FINDINGS: Intraoperative pain scores were not different between two groups and fentanyl requirement was similar. The onset of tourniquet pain was similar in case (21.96±3.87 min) and control group (21.12±3.33 min) (p=0.41). Analgesia time and time of initial analgesic requirement after tourniquet deflation was 54.4±9.95 min in control group and 60.40±10.17 min in case group (p=0.625).CONCLUSION: Addition of nitroglycerine to LIDOCAINE was not improved the quality of IVRA, postoperative analgesia and opioid requirements in patients undergoing hand surgery.

Background: The most important side effect of venous (Bier) block is systemic toxicity induced by local anesthetics. This is occurred by accidental tourniquet release after drugs’ injection. Effects of sensory and motor block of LIDOCAINE increase by use of sub anesthetic dose of ketamine with LIDOCAINE simultaneously and its toxicity reduces. To evaluate the sensory and motor block via venous block in patients under upper extremity, surgeries induced by LIDOCAINE compared to LIDOCAINE and ketamine.Material and Methods: Forty ASA physical status I-II patients, undergoing elective surgery of the hand or the forearm, were studied in Shahid Rajaee University Hospital. Patients divided in two groups randomly (n=20). The affected extremity was exsanguinated by elevating it and wrapping it with an esmarsh bandage.The proximal double- cuffed tourniquet was inflated on the arm of affected extremity and local anesthetics administered (each patient in control group received with 40 ml of LIDOCAINE 0.5% and each patient in intervention group received 40 ml of LIDOCAINE 0.25% plus ketamine 0.1% (40 mg)). Sensory blocking was assessed by using a blunt pin every 1 minute after local anesthetic injection. Motor block also assessed based on patient’s ability to move the operative hand fingers. Data were analyzed using t- test.Results: the mean time of sensory and motor blocks were 4.25±0.63 and 7.65±0.24 minutes in control group and 4.35±0.62 and 8.35±0.67 minutes in intervention group respectively. Time of motor block was significantly longer in LIDOCAINE and ketamine group compared to LIDOCAINE group (p=0/003).Conclusion: Using LIDOCAINE combined with ketamine is safe method for the intravenous regional anesthesia especially in surgeries on hand or forearm. In this method LIDOCAINE doses for blocking is lessen and reach to nontoxic level.

Background: Intravenous regional anesthesia (IVRA) is a easy and reliable method for extremity injuries. To improve block quality, decrease tourniquet pain and postoperative analgesia different drugs has been used as an adjuvant in IVRA. In this study, we evaluated the effect of nitroglycerin (NTG) in quality improvement when added to LIDOCAINE and Meperidine as an adjuvant in IVRA.Material and Methods: Fifthly patient with upper extremity injury under IVRA were randomly and blindly to two groups. Under identical condition, control group received total dose of 200 mg LIDOCAINE and 20 mg Meperidine diluted with saline (40cc) and study group received 200 mg LIDOCAINE and 20 mg Meperidine plus 200mg Nitroglycerine. Onset time, anesthesia quality, tourniquet pain and analgesic use were assessed during surgeryAfter tourniquet deflation, the tim. e to first analgesic requirement and side effect were noted.Results: The sensory block onset time were shortened in study groups (3.7±1.1 vs 5.1±1.3) (P=0.004).Intraoperative pain score and quality of analgesic were not different between two groups and fentanyl requirement was similar. The onset of postoperative pain were similar in study and control groups. [78.79 (61.28- 92.23) vs 52.28 (35.07-73.448)]. (P=0.29) Conclusion: Addition of Nitroglycerine to LIDOCAINE and Meperidine in intravenous regional anesthesia shortens onset times of sensory block but is not improved the quality of intraoperative analgesia and postoperative pain in patients undergoing hand surgery.

BACKGROUND AND OBJECTIVE: The control of postoperative pain that is one of the main goals of anesthesia care can lead to patients satisfaction and reduce time and expense of hospitalization. This study was done to compare the postoperative analgesia indices of free LIDOCAINE spinal anesthesia with LIDOCAINE plus buprenorphine. METHODS: This clinical trial study was performed on 100 patients aged 17-80 years in ASA Class I. They were randomly divided into two groups (each group=50). In group 1 (control), 75-100 mg LIDOCAINE (5%) with 0.5 ml distilled water and in group 2 (study), 75-100 mg LIDOCAINE (5%) plus 50 µg buprenorphine were injected intrathecally equal volumes. Patients were followed up for 24 hrs because of vital sign, severity of pain and respiratory rate and then compared to each other. FINDINGS: The mean duration of postoperative analgesia in group 1and 2 were 2.1 and 22.7 hours, respectively (p=0.000). The difference of range of hemodynamic changes was not statistically significant. CONCLUSION: According to the results, the mean duration of postoperative analgesia in study group (Buprenorphine+LIDOCAINE) was longer than the control group and there were no hemodynamic changes between two groups.

Introduction: Increasing use of regional anesthesia instead of general anesthesia may be the most important factor in decreasing anesthetic difficulties (e.g. difficult intubations, aspiration pneumonia, and analgesic side effect) in caesarean section. Quality of regional anesthesia is improved by adding morphine, fentanyl and sufentanil. The function of Epinephrine is dose-dependent. For instance, in small dosage, it has stimulating effects on Beta1 and Beta2 causing venous stasis to minimize. However, in large doses, Epinephrine’s Alfa adrenergic is dominant. This study aimed at investigating the potential hemodynamic effects of adding Epinephrine to LIDOCAINE during spinal anesthesia on expecting mothers who are candidates of caesarean section.Materials and Methods: This study was a prospective, randomized, double-blind, controlled trial on 100 pregnant women who were candidates for caesarean section with ASA class I, II in the year of 1387.The subjects of the study were divided into two groups, (1) and (2) on the basis of the randomized digital table as follows: Group 1: 80 mg LIDOCAINE 5% +2 micro gram sufentanil Group2: 80 mg LIDOCAINE 5%+2 micro gram sufentanyl+0.2 mg (0.2cc) Epinephrine. Both groups received the drugs intrathecally. Vital signs such as systolic and diastolic blood pressure, pulse rate and SPO2 were recorded both before the anesthesia and thereafter every 5 minutes until the end of the operation. The measuring procedure continued during and after the recovery stage. Besides, the side effects and the drugs needed were recorded.Results: According to the findings in this study, there weren't any significant differences between the two groups in terms of age, weight, ASA, NPO timing and the previous surgery. There weren't any significant differences between the two groups of the study in terms of systolic and diastolic blood pressure, either. However, some hypotension was noted in Adrenaline group. Also, there weren't any significant differences in PR but some bradycardia was seen in Adrenaline group, too. There weren't any significant differences in SPO2 and side effects (nausea, vomiting, dysphagia, respiratory disorder, shivering) between the two groups.Conclusion: Adding Epinephrine to LIDOCAINE 5% increased the duration of spinal aesthesia in caesarean section whereas no significant difference was observed in terms of hemodynamic and side effects. Nevertheless, regarding the emergence of hypotension and bradycardia observed in the Adrenaline group, no matter how rare, close control of hemodynamic in this group is essential.

The action of corticosteroids in prolongation of the analgesic effects of local anesthetics in peripheral nerves is well documented. The objective of this study is to compare the sensory and motor blockade duration of intrathecal LIDOCAINE plus dexamthasone versus plain LIDOCAINE and LIDOCAINE plus epinephrine.Ninety ASA I or II 20 to 45 year old men, undergoing lower abdominal surgery under spinal anesthesia with less than 60 min duration and sensory level lower than T6, in Dr. Shariaty Hospital in winter 1381, were selected for the randomized double blind prospective study. The patients were randomly allocated to LIDOCAINE- dexamethasone (75mg LIDOCAINE plus 8mg dexamethasone intrathecally), LIDOCAINE (75mg LIDOCAINE plus 2ml normal saline intrathecally) and LIDOCAINE- epinephrine (75mg LIDOCAINE plus 0.2mg epinephrine 1/1000 and 2 ml normal saline intrathecally) groups. Four level regression of sensory level was assumed as the end of sensory block. The duration of sensory and motor block, hypotension, bradycardia, nausea and vomiting and neurological complications were assessed.There was no significant difference between age, weight, ASA class initiation time of sensory and motor block and time in attaining the highest level of block. The duration of sensory block was significantly longer in the LIDOCAINE - epinephrine and LIDOCAINE- dexamethasone groups than the LIDOCAINE group (respectively 85.7 and 82.1 min vs. 55.9 min for sensory block and 112.8 and 118.9 min vs. 79.2 for motor block; p<0.001). The incidence of nausea and vomiting and antiemetic administration, hypotension and bradycardia that needed treatment had no significant difference (p>0.05). No neurological deficit or other significant adverse effects were recorded.The addition of intrathecal dexamthasone to LIDOCAINE significantly improves the duration of sensory and motor block following spinal anaesthesia without significant side-effects.

This blinded, randomized experimental study was designed to evaluate the analgesic effects of adding epinephrine or xylazine to LIDOCAINE solution for brachial plexus block (BPB) in sheep. Nine healthy, fat-tailed female lambs (26.6±1.5 kg) were randomly allocated into three groups: LIDOCAINE 2%, 5 mg kg-1 (LID, n=6), LIDOCAINE (5 mg kg-1) with epinephrine 5 mg mL-1 (LIDEP, n=6) or LIDOCAINE (5 mg kg-1) with xylazine 0.05 mg kg-1 (LIDXY, n=6). Each animal was tested twice. The sheep received a total volume of 0.25 mL kg-1 for BPB. A nerve stimulator was used to locate the nerves of the brachial plexus. Onset and duration of analgesia of the forelimb were evaluated using superficial and deep pin prick and pinching of skin with a hemostat clamp. Heart and respiratory rates, and rectal temperature were recorded before and at predetermined intervals following the completion of the block. Brachial administration of LID, LIDEP or LIDXY produced forelimb analgesia within 11.3, 11.0 and 7.0 minutes, respectively. The mean duration of analgesia was 100.0 min in LID and 133.2 min in LIDEP group. The mean duration of analgesia in LIDXY group (186.8 min) was significantly longer compared with LID group. In LIDEP group a significant increase in heart rate occurred 5 min after drug administration. Heart rate decreased from 35 to 80 min in sheep received LIDXY. In conclusion, the addition of xylazine to LIDOCAINE solution for BBP provided a prolonged duration of action without any adverse effects in fat-tailed sheep.

Background: Intravenous regional anesthesia is a simple and reliable method for upper extremity surgery. In order to increase the quality of blocks and reduce the amount of pain, many drugs are used with LIDOCAINE. In this study, the effect of ketorolac-LIDOCAINE in intravenous regional anesthesia was investigated. Methods: 40 patients undergoing elective upper limb with America Society of Anesthesiologists class I and II were selected and randomly divided into two groups. The first group of 20 patients received 200 mg of LIDOCAINE, and the second group, 200 mg of LIDOCAINE with 20 mg of ketorolac. In both groups, the drug was diluted to 40 ml. In both groups, the onset of sensory block, onset of tourniquet pain, the onset of pain after opening the tourniquet, score of postoperative pain and analgesic prescription in the first 24 hours, during 1, 6, 12 and 24 hours were studied. A measure of the quality of analgesia was evaluated by VAS. Results: The mean onset of tourniquet pain in the two groups was not significantly different (P=0. 443). In the ketorolac group, the onset of pain after opening the tourniquet was significantly longer than LIDOCAINE group (p<0. 001). The mean postoperative pain score during the first 24 hours after surgery in the ketorolac group was significantly lower than LIDOCAINE group (p<0. 001). The average number of analgesia prescription during the 24 hours after operation was significantly lower in ketorolac group than LIDOCAINE group (p<0. 001). Conclusions: Adding ketorolac to LIDOCAINE for regional anesthesia can reduce the postoperative pain for up to 24 hours after opening the tourniquet.

Background: Different medicines are utilized in giving nerve block. The different drugs are usually discussed concerning efficacy and persistence of pain relief. The present study aimed to compare the use of LIDOCAINE alone with granisetron/LIDOCAINE combination in terms of the efficacy and persistence of the analgesic effect, in the axillary block used in patients requiring elbow or below elbow surgery. Methods: A double-blind randomized clinical trial was performed on 90 patients who were candidates for elbow surgery. In this regard, an ultrasonography-guided axillary block was performed by a linear transducer using a short-axis in-plane technique. The first group was given LIDOCAINE, whereas the second group received granisetron/LIDOCAINE combination. First, five mg/kg of LIDOCAINE %0. 5 was diluted to 40 ccs with 0. 9% saline. In the first group, 40ml of LIDOCAINE solution was injected after dipping the syringe in epinephrine. In the second group, 2 mg of granisetron was injected simultaneous with LIDOCAINE solution. Results: In total, 90 patients entered the study and were divided into two equal groups of 45. The mean age of the patients was 34. 48± 9. 0 years (18-58 years). 61 (67. 8%) participants were male and 29 (32. 2%) female. The onset time of sensory and motor block in the second group (granisetron/LIDOCAINE combination) was significantly lower, compared to the LIDOCAINE-alone group. Moreover, the continuity of sensory and motor block was significantly higher in the second group. Furthermore, the first analgesic requirement time was significantly lower in the granisetron/LIDOCAINE combination group, compared to the LIDOCAINE-alone group (P<0. 001). Conclusion: The concomitant use of granisetron with LIDOCAINE improved all pain indicators and also led to faster and more continuous sensory and motor blocks.