COMPARATIVE STUDY OF 0.5%

LIDOCAINE AND 0.2% ROPIVACAINE

IN INTRAVENOUS REGIONAL

ANAESTHESIA FOR HAND SURGERIES

Dr.A.GOWRISHANKAR. PG

DEPT OF ANESTHESIOLOGY THANJAVUR MEDICAL COLLEGE

• To compare the anaesthetic efficacy,

post-operative analgesia, side-effects between

lidocaine 0.5%and ropivacaine 0.2% when

intravenous regional anesthesia was used in

hand surgeries

METHODS AND MATERIALS• Approval from institutional ethical committee and written

consent from the patient

• 40 adult patients ASA I , II

• Pts allocated into two groups (Randomised control study)

Group I : (n=20) : Lidocaine 0.5% (3 mg/kg)

Group II : (n=20) : Ropivacaine 0.2% (1.2 mg/kg)

• elective and emergency hand surgeries lasting less than one hour

EXCLUSION CRITERIA• ASA III ,IV

• Liver and renal disease

• Sickle cell disease

• Cardiac conduction abnormalities

• Neurological & vascular abnormalities

• Uncontrolled hypertension

• Diabetic neuropathy

• Pregnancy • h/o seizure

• Fasting guidelines were followed

• 18 g iv cannula on non operative side

• 20 g iv cannula was inserted in the distal vein on the dorsum of the hand of the operative extremity

• Baseline PR,BP ,SPO2 ,RR were recorded.

• Exsanguination with esmarch bandage • Circulation was occluded by the proximal cuff of a double cuffed

pneumatic tourniquet

• Distal cuff inflated and proximal cuff deflated when VNPRS > 5

• After completion of surgery tourniquet deflated in biphasic manner.

MONITORING

• Tourniquet inflation and deflation time.

• Onset of sensory and motor blockade.

• Intra-op hemodynamics.

• Intra-op tourniquet pain.

• Sensory and motor recovery time.

• Duration of post –op analgesia.

• Total dose of rescue analgesics.

• complication.

sex

male female0

2

4

6

8

10

12

14

16

gr 1gr 2

No

of

patie

nts

DIAGNOSIS

CUT INJ HAND

GANGLION INJ F4F5 INJ INDEX INJ THUMB0

1

2

3

4

5

6

7

8

9

gr 1

gr 2

• No of patients

ONSET OF SENSORY ANALGESIAGROUP N MEAN

(min)STD DEVIATION

1 20 4.40 1.0952 20 6.65 1.182

T-TEST FOR EQUALITY OF MEANS

SIGNIFICANCE

Equal variance assumed 0.09 ( NOT SIGNIFICANT)

Equal variance not assumed 0.08 (NOT SIGNIFICANT

ONSET OF MOTOR BLOCKADEIndependent samples testGROUP N MEAN

(min)STD DEVIATION

1 20 7.70 1.261

2 20 11.30 1.720

T-TEST FOR EQUALITY OF MEANS

SIGNIFICANCE

Equal variance assumed 0.09 ( NOT SIGNIFICANT)

Equal variance not assumed 0.08 (NOT SIGNIFICANT

VNPS 20 MIN

0 1 2 3 4 5 60

2

4

6

8

10

12

14

gr1gr 2

No of patients

VNPS P (<0.05)

VNPS 40 MIN

0 1 2 3 4 5 6 70123456789

10

GR 1 GR2

No of patients

VNPS (P<0.05)

SENSORY REGRESSIONIndependent samples test

T –TEST FOR EQUALITY OF MEANS

SIGNIFICANCE ( 2 tailed)

Equal variance assumed .000 (P < 0.05)

Equal variance not assumed .000 (P < 0.05)

GROUP N MEAN (min) STD DEVIATION

1 20 5.15 0.933

2 20 18.00 3.974

MOTOR REGRESSIONIndependent samples test

T-TEST FOR EQUALITY OF MEANS SIGNIFICANCE ( 2- tailed)

Equal variances assumed .000 (P <0.05)

Equal variances not assumed .000 (P <0.05)

GROUP N MEAN (min) STD DEVIATION

1 20 7.20 0.9512 20 23.50 3.720

POST OP ANALGESIAIndependent samples test

T- TEST FOR EQUALITY OF MEANS

SIGNIFICANCE(2-tailed)

Equal variance assumed .000 (P < 0.05)

Equal variance not assumed .000 (P < 0.05)

GROUP N MEAN (min) STD DEVIATION

1 20 186.50 25.500

2 20 401.75 27.638

Post op analgesic doseChi-square test

Exact significance(2- sided)

Pearson chi square 0.014

Likelihood ratio 0.007

Fisher’s exact test 0.235

POST OP ANALGESIC DOSE REQUIREMENT

75 mg 150 mg0

2

4

6

8

10

12

14

16

Gr 1Gr 2

complications

side effect0

1

2

3

4

5

6

7

8

gr 1

• Metallic taste• Light

headedness• Nausea• Tinnitus• seizure

No of patients

CONCLUSION

• We conclude that ropivacaine 0.2% provides

prolonged analgesia, lower post-op rescue

analgesics requirement, and lesser side

effects and hence an alternative to lidocaine

0.5% in Intravenous regional anesthesia for

hand surgeries.

Literature search ……• Anesthesia and Analgesia 1999 :89 (727-31): yale university of

medicine, New haven ,Connecticut

• Clinical anesthesia 2009 dec 21 vol :8

• Thomas Jefferson university , Anesthesiology june 1999- vol 90 Issue 6

• Cukurova university faculty of medicine,adana turkey

• Pubmed.2002 nov-dec :27 (6) : 595-9

• Toronto western hospital university of Toronto ,Toronto ,Ontario ,Canada

• Acta anesthesiologica scandinavica vol:48 issue 1

• Canadian journal of anesthesia/springer New York vol:49, num 2 /feb ,2002

Thank u………