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597: Addition of Midazolam to Lidocaine for Intravenous Regional Anesthesia
96
Posters
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Peripheral Nerve Blocks
567. Evaluation of block success and patient satisfaction in axillary brachial plexus blockade by multiple nerve stimulation technique in orthopaedic surgery N. Serto¨z, E. Bayraktaroglu, O. Eris, H. Ayanoglu Ege University School of Medicine, Anesthesiology, Izmir, Turkey Multiple nerve stimulation technique for axillary block provides successful blockade by injecting local anaesthetic solution near the four-nerves of the plexus. In this study, we retrospectively evaluated the patient satisfaction, efficiency, and complications during routine use of this technique. Methods: We evaluated 100 consecutive ASA I and II status patients who have undergone hand or forearm surgery under brachial plexus blockade by multiple stimulation technique. A 1mA pulses at 2Hz and 0.1ms was used. Nerves were located according to the specific motor responses to their stimulation(N.musculocutaneous, ulnaris, radialis, medianus). In each procedure needle position was optimized at the point of motor response when the current was decreased to 0.3 or 0.5 mA and a local anesthetic (LA) mixture was injected separately to each nerve (LA solution: equal volumes of % 0.5 bupivacaine and %2 prilocaine. Maximum of 40 ml injected). The patients were questioned at 24th hours. Results: The block performance time was 10⫾3min; motor blockade onset time was 14⫾4min; sensory blockade onset time 11⫾3min; reversal of motor blockade time was 527⫾115min; sensory blockade reversal time was 608⫾117min. The impressions of the patients about the blockades were classified as 64%“Very satisfied” and 32% as“Satisfied” and the sum of 96% was assigned as the patients who want to have a similar operation with the same anesthesia in the future. The impression of the performer was as “Very easy block: Very Well”(81%), “A little bit difficult but good block: Good”(14%). Conclusion: Blocking at least the three of the brachial plexus nerves by the axillary approach resulted in a block efficiency of 95%. Brachial plexus blockade by multiple stimulation technique via axillary approach is useful in the forearm and hand surgery as it provides a highly successful and efficient anesthesia and a high rate of full patient satisfaction.
597. Addition of midazolam to lidocaine for intravenous regional anesthesia P. Kashefi, K. Montazeri, H. Mirzaei Alzahra University Hospital, Anesthesia and Critical Care, Isfahan, Islamic Republic of Iran Background and Aims: Intravenous regional anesthesia (IVRA) is an effective method for providing anesthesia as well as a bloodless field during hand surgery. The ideal IVRA must have the following features: rapid onset reduced intraoperative pain, and prolonged post - deflation analgesia. In an attempt to improve perioperative analgesia and to shorten onset time of sensory and motor block, various drugs have been administered concomitantly with the local anesthetic in IVRA with controversial results; morphine, fentanyl, meperidine, aspirin, ketorolac and bicarbonate are among those agents. Methods: After approval of ethics committee of university in a randomized, double- blind, clinical trial study 60 ASA I and II patients undergoing elective hand surgery divided in 2groups. Intravenous regional anesthesia was achieved using 3 mg/kg lidocaine 0.5 % diluted with saline to a total volume of 40 ml in the control group or midazolam plus 3 mg/kg lidocain 0.5 % diluted with saline to a total volume of 40 ml in the midazolam group . The onset and the regression time for sensory and motor block quality of anesthesia, intraoperative, and postoperative analgesic requirements were recorded. Results: The onset time of sensory and motor block in the midazolam group was shorter than in the control group. The duration of sensory block in the midazolam group was longer than in the control group. The quality of anesthesia was better in the midazolam group than in the control group. Sensory and Motor block regression was longer in the midazolam group than in the control group. Analgesic requirement was greater in control group. Conclusions: The addition of midazolam to lidocaine in intravenous regional anesthesia shortened the sensory and motor block onset times, improved the quality of anesthesia, and decreased analgesic requirement.
Posters
•
Peripheral Nerve Blocks
567. Evaluation of block success and patient satisfaction in axillary brachial plexus blockade by multiple nerve stimulation technique in orthopaedic surgery N. Serto¨z, E. Bayraktaroglu, O. Eris, H. Ayanoglu Ege University School of Medicine, Anesthesiology, Izmir, Turkey Multiple nerve stimulation technique for axillary block provides successful blockade by injecting local anaesthetic solution near the four-nerves of the plexus. In this study, we retrospectively evaluated the patient satisfaction, efficiency, and complications during routine use of this technique. Methods: We evaluated 100 consecutive ASA I and II status patients who have undergone hand or forearm surgery under brachial plexus blockade by multiple stimulation technique. A 1mA pulses at 2Hz and 0.1ms was used. Nerves were located according to the specific motor responses to their stimulation(N.musculocutaneous, ulnaris, radialis, medianus). In each procedure needle position was optimized at the point of motor response when the current was decreased to 0.3 or 0.5 mA and a local anesthetic (LA) mixture was injected separately to each nerve (LA solution: equal volumes of % 0.5 bupivacaine and %2 prilocaine. Maximum of 40 ml injected). The patients were questioned at 24th hours. Results: The block performance time was 10⫾3min; motor blockade onset time was 14⫾4min; sensory blockade onset time 11⫾3min; reversal of motor blockade time was 527⫾115min; sensory blockade reversal time was 608⫾117min. The impressions of the patients about the blockades were classified as 64%“Very satisfied” and 32% as“Satisfied” and the sum of 96% was assigned as the patients who want to have a similar operation with the same anesthesia in the future. The impression of the performer was as “Very easy block: Very Well”(81%), “A little bit difficult but good block: Good”(14%). Conclusion: Blocking at least the three of the brachial plexus nerves by the axillary approach resulted in a block efficiency of 95%. Brachial plexus blockade by multiple stimulation technique via axillary approach is useful in the forearm and hand surgery as it provides a highly successful and efficient anesthesia and a high rate of full patient satisfaction.
597. Addition of midazolam to lidocaine for intravenous regional anesthesia P. Kashefi, K. Montazeri, H. Mirzaei Alzahra University Hospital, Anesthesia and Critical Care, Isfahan, Islamic Republic of Iran Background and Aims: Intravenous regional anesthesia (IVRA) is an effective method for providing anesthesia as well as a bloodless field during hand surgery. The ideal IVRA must have the following features: rapid onset reduced intraoperative pain, and prolonged post - deflation analgesia. In an attempt to improve perioperative analgesia and to shorten onset time of sensory and motor block, various drugs have been administered concomitantly with the local anesthetic in IVRA with controversial results; morphine, fentanyl, meperidine, aspirin, ketorolac and bicarbonate are among those agents. Methods: After approval of ethics committee of university in a randomized, double- blind, clinical trial study 60 ASA I and II patients undergoing elective hand surgery divided in 2groups. Intravenous regional anesthesia was achieved using 3 mg/kg lidocaine 0.5 % diluted with saline to a total volume of 40 ml in the control group or midazolam plus 3 mg/kg lidocain 0.5 % diluted with saline to a total volume of 40 ml in the midazolam group . The onset and the regression time for sensory and motor block quality of anesthesia, intraoperative, and postoperative analgesic requirements were recorded. Results: The onset time of sensory and motor block in the midazolam group was shorter than in the control group. The duration of sensory block in the midazolam group was longer than in the control group. The quality of anesthesia was better in the midazolam group than in the control group. Sensory and Motor block regression was longer in the midazolam group than in the control group. Analgesic requirement was greater in control group. Conclusions: The addition of midazolam to lidocaine in intravenous regional anesthesia shortened the sensory and motor block onset times, improved the quality of anesthesia, and decreased analgesic requirement.