USE OF NEOSTIGMINE TO AUGMENT INTRAVENOUS REGIONAL ANESTHESIA USING LIGNOCAINE IN UPPER LIMB SURGERY

Abstract

Objectives To evaluate the effects of neostigmine on onset and duration of Intravenous regional anesthesia (IVRA) when added to lignocaine.
Study Design: Randomized control trial.
Place and duration of study: Combined Military Hospital Rawalpindi from 21 September 2006 to 23 April 2008.
Patients and Methods: One hundred patients undergoing hand surgery were randomly assigned to two groups to receive IVRA. The control group received 1mililiter (mL) of saline plus 3 miligram per kilogram(mg/kg) of lignocaine diluted with saline to a total dose of 40 mL, the study group received 0.5 mg (1ml) of neostigmine plus 3 mg/kg of lignocaine diluted with saline to a total dose of 40 mL. Sensory block and motor block onset and recovery were noted. Heart rate, mean arterial blood pressure, and oxygen saturation values were noted before surgery 1min, 5 min, 10 min, 20 min, and 40 min and after tourniquet release. Time to first analgesic requirement was also noted.
Results: The mean sensory block onset was 4.14 min as compared to 10.1 min in control group. Mean value of motor block onset was 6.3 min as compared to 13.8 min in control group.similarly mean for sensory recovery was 6.9 min as compared to 3.1 min for control group. Mean value for motor recovery was 5.17 min as compared to 2.17 min in control group.
Experiment group had their demand for analgesics after a mean of 35.3 min and control group had their analgesia after 16.5 min. There was highly significant difference in all the variables.
Conclusion: We concluded that neostigmine as an adjunct to lignocaine improves quality of anesthesia and is beneficial in IVRA.