Ulus Travma Acil Cerrahi Derg. 2011; 17(6): 497-503 | DOI: 10.5505/tjtes.2011.30643

Travma hastalarýnda intravenöz rejyonel anestezi için lidokaine eklenmesi durumunda üç farklý nitrogliserin dozunun analjezik etkisi

Azim Honarmand, Mohammadreza Safavi, Abas Fatemy
Ýsfahan Týp Bilimleri Üniversitesi, Anesteziyoloji Ve Yoðun Bakým Araþtýrma Merkezi, Ýsfahan, Ýran

AMAÇ
Nitrogliserin (NTG), analjezik özelliklere sahiptir. Mevcut çalýþmanýn amacý, travma hastalarýnda intravenöz rejyonel anestezide (IVRA) lidokain eklendikten sonra üç farklý NTG dozunun (200 µg, 300 µg ve 400 µg) analjezik etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM
El cerrahisi uygulanan 100 hasta rastgele dört gruba ayrýldý: Kontrol grubunda serum fizyolojik ile toplam 40 mL’lik bir doza dilüe edilen 3 mg/kg %2 lidokain (Grup LS, n=25) veya NTG grubunda serum fizyolojik ile toplam 40 mL’lik bir doza dilüe edilen 200, 300, 400 µg NTG + 3 mg/kg 2% lidokain (sýrasýyla Grup LN1, Grup LN2, Grup LN3; her bir grupta n=25) uygulandý. Turnike uygulamasýndan önce ve sonra, hemodinamik deðiþkenler, turnike aðrýsý, sedasyon ve kullanýlan analjezik kullanýmý kaydedildi.
BULGULAR
Duysal ve motor bloðun baþlama zamanlarý, LN1, LN2 ve LS gruplarýna göre LN3 grubunda anlamlý þekilde daha kýsaydý (p<0,05). Duysal ve motor bloðun geriye dönme zamanlarý, LN1, LN2 ve LS gruplarýna kýyasla LN3 grubunda anlamlý þekilde daha uzundu (p<0,05). Ameliyat sonrasý vizüel analog skala (VAS) skorlarý, LS-grubuna kýyasla LN3 grubunda turnikenin gevþetilmesinden 2., 4., 8., 12. ve 24. saat sonra anlamlý þekilde daha düþüktü (p<0,05).
SONUÇ
IVRA’da lidokaine 400 µg NTG’nin eklenmesi, 200 µg veya 300 µg NTG’nin eklenmesine göre, travma hastalarýnda yan etkilere yol açmaksýzýn, duysal ve motor bloðun baþlama zamanýný kýsaltýr, anestezi kalitesini ve perioperatif analjeziyi artýrýr.

Anahtar Kelimeler: Anestetik teknikler, lidokain; nitrogliserin; turnike aðrýsý; travma hastalarý.

---

The analgesic effect of three different doses of nitroglycerine when added to lidocaine for intravenous regional anesthesia in trauma patients

Azim Honarmand, Mohammadreza Safavi, Abas Fatemy
Anesthesiology And Critical Care Research Center, Isfahan University Of Medical Sciences, Isfahan, Iran

BACKGROUND
Nitroglycerine (NTG) has analgesic properties. The aim of the present study was to assess the analgesic effect of three different doses of NTG (200 µg, 300 µg and 400 µg) when added to lidocaine in intravenous regional anesthesia (IVRA) in trauma patients.
METHODS
One hundred patients undergoing hand surgery were randomly allocated to four groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL in the control group (Group LS, n = 25) or 200, 300, 400 µg NTG plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL in the NTG group (Groups LN1, LN2, LN3 respectively; n = 25 in each group). Before and after the tourniquet application, hemodynamic variables, tourniquet pain, sedation, and analgesic use were recorded.
RESULTS
Sensory and motor block onset times were significantly shorter in the LN3 group compared with Groups LN1, LN2, and LS (p<0.05). Sensory and motor block recovery times were statistically prolonged in the LN3 group when compared with Groups LN1 and LS (p<0.05). Postoperative visual analogue scale (VAS) scores were significantly lower at 2, 4, 8, 12, and 24 hours after tourniquet release in Group LN3 compared with Group LS (p<0.05).
CONCLUSION
The addition of 400 µg NTG to lidocaine in IVRA shortens the onset of sensory and motor block in trauma patients and improves the quality of anesthesia and perioperative analgesia better than the addition of 200 µg or 300 µg NTG, without causing side effects.

Keywords: Anesthetic techniques, lidocaine; nitroglycerin; tourniquet pain; trauma patients.

---

ATIF KOPYALA