Triple drug intravenous regional anesthesia is safe and equally effective (0.25% lignocaine plus 1 ?g/kg fentanyl + 0.5 mg pancuronium) as compared to standard Bier's block (0.5% lignocaine)

Intravenous regional anesthesia requires a tiny practice to obtain good results and proves economical. We evaluated the efficacy of fentanyl (1 ?g/kg) and pancuronium (0.5 mg) in lower doses with 0.25% lignocaine (1.5 mg/kg) for intravenous regional anesthesia for upper limb surgeries for a period not exceeding one hour, additionally we also compared the above study with standard Bier's block i.e. intravenous regional anaesthesia with 0.5% lidocaine (0.5 mg/kg body weight). This study was conducted in a medical college government general hospital, in Andhra Pradesh over the period of 3 years during 2001 to 2004. Fifty patients belonging to ASA grade I and grade II undergoing upper limb surgery were selected. Patients were included if they were undergoing upper limb surgeries for a period not exceeding one hour. These patients were assigned in a randomized, double fashion to two groups: Group A received 0.6 ml/kg of 0.5 % lidocaine (3 mg/kg) and Group B received 0.6 ml/kg of 0.25 % lidocaine (1.5 mg/kg) plus fentanyl (1 ?gm/kg) and pancuronium (0.5 mg). The patients were observed for two hours after the release of the tourniquet for any complications like bradycardia, hypotension, and convulsions etc. The present was compared with standard Bier's block, i.e., 0.5% lidocaine (3 mg/kg body weight). Data was presented as Mean±SD, actual numbers and percentages and analyzed using SPSS version 16. In this study, 50 patients undergoing various upper limbs, surgeries were given intravenous regional anesthesia which included 38 males and 12 females. The postoperative analgesia was slightly greater in Group B compared to Group A. The onset of sensory and a motor blockade were earlier in Group A patients when compared to Group B patients. Short delay observed with this new method in the onset of sensory and motor blockade should be noted and the start of surgical procedures delayed until 15-20 minutes after tourniquet inflation. There was no difference in the quality of analgesia and muscle relaxation between two groups. The triple combination of lidocaine, fentanyl and pancuronium can be considered as is safe and effective since the dose of lignocaine can be reduced to a non-toxic level with the same quality of anesthesia. However, the limiting factor in this new technique is a short delay in the onset of sensory and motor blockade compared to standard Bier's block.