The impact of Verapamil addition to Ketamine and Lidocaine Intravenous regional Anesthesia: A Randomized controlled study

Background: The use of adjuncts along with Lidocaine during intravenous regional anesthesia (IVRA) decreases tourniquet pain and prolongs post-operative analgesia. Addition of ketamine reduces the time for onset of block, delays the onset of tourniquet pain and reduces postoperative analgesic requirement. Verapamil potentiates the effect of neuromuscular blocking agents. This study was designed to evaluate the effect of adding Verapamil (2.5 mg) to Lidocaine plus Ketamine (0.5 mg/kg) in comparison with lidocaine plus ketamine IVRA. Materials and methods: Hundred and twenty patients, aged 18–50 years, ASA physical status I and II undergoing elective hand or forearm surgery under Bier's Block lasting one to one and half hours were included in this double-blinded, randomized and controlled study. Patients were divided into two groups of 60 patients each. Group- I (control group) received 40 ml of 0.5% Lidocaine plus ketamine (0.5 mg/kg) and Group- II received an addition of 2.5 mg of verapamil IVRA. Sensory and motor block onset and recovery time were noted. After the tourniquet deflation: pain, sedation values, time to first analgesic requirement and side effects were evaluated over a period of 12 hours. Results: Significant postoperative hemodynamic changes, sedation score, pain score and delayed first request for analgesia was observed in-group II when compared to group I. Sensory and motor block characteristics were significant in-group II as against group I. The side effect profile of verapamil (2.5mg) was minimal with a few episodes of hypotension and bradycardia, which were clinically managed by ephedrine and atropine respectively. Conclusions: Adding verapamil 2.5 mg to Lidocaine plus ketamine (0.5 mg/kg) for IVRA proved to be an effective and safe adjuvant for acute pain after surgery..