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………