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A New Approach to Intravenous Regional Anesthesia

Departments of Anesthesiology, College of Medicine, University of Basrah, Basrah, Iraq, and University of Heidelberg, Heidelberg, Germany

In an attempt to reduce the dose of local anesthetic during intravenous (IV) regional anesthesia of the upper limb, we combined 100 mg of lidocaine with 0.05 mg of fentanyl and 0.5 mg of pancuronium. The study was designed in a randomized, double-blind fashion to determine the efficacy of this approach in providing analgesia and relaxation during surgery and to evaluate its safety after immediate deflation of the tourniquet following IV drug injection. Eighty unpremedicated patients, ASA physical status I or II, were assigned to the following groups: group A (n = 15) received 100 mg of lidocaine diluted in 40 mL of NaCl IV; groups B-D (n = 15 in each group) received 100 mg of lidocaine diluted in NaCl, with the addition of 0.05 mg of fentanyl (group B) or 0.5 mg of pancuronium (group C), or both (group D) to a total volume in all groups of 40 mL. Patients in groups A-D underwent elective operations on the forearm, wrist, and hand; for evaluation of safety, in 20 volunteers (group E) the tourniquet was immediately released after IV injection of the three drugs at the previously described doses. The analgesic effect was more profound in group D compared with groups A-C. In group D, 9 of 15 patients had excellent analgesia. In six patients, pain was experienced at the beginning of surgery, but 5 min thereafter patients remained pain free. In group B, analgesia was obtained successfully in only 26.6% of cases compared with group A with 13.3%. Skeletal muscle relaxation was profound in groups C and D compared with groups A and B. Signs indicating toxicity were not encountered after release of the tourniquet in these groups. In group E, the volunteers complained of minor events, such as mild dizziness and transient visual disturbances. In one case, vomiting and hypotension with a systolic arterial blood pressure of 90 mm Hg occurred 5 min after release of the tourniquet. In conclusion, this approach to IV regional anesthesia with the combination of lidocaine, fentanyl, and pancuronium offers adequate analgesia and relaxation during upper limb surgery.

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