Effect of Adding Different doses of Atracurium to Lidocaine on the Quality and Safety of Local Intravenous Anaesthesia for Upper Extremities Surgery

Abstract Background: Intravenous regional anesthesia (IVRA) was first described by August Bier in 1908 for anesthesia of the hand and forearm. The primary advantages of IVRA are its simplicity, reliability, and cost-effectiveness with high success rates. Various adjuncts added to LA have been investigated in an attempt to improve the quality of IVRA, including muscle relaxants. Non-depolarizing neuromuscular blocking agents can be of benefit in hastening the onset of motor block and creating a more profound muscle relaxation state. These benefits have been found to facilitate fracture reduction and also improve overall analgesia in young, muscular patients without clinically evident side effects. Aim of Study: The aim of this study was to evaluate the effects and safety of different doses of atracurium when added to lidocaine for IVRA, on quality and duration of anaesthesia by determining the duration of onset and regression times of sensory and motor blocks, intraoperative and postoperative analgesia. Patients and Methods: The current randomized, clinical trial was conducted on 60 patients considered candidates for upper extremities surgery in Alqassim National Hospital, Saudia Arabia. The patients were randomly assigned into four groups. Group 1 (control group) only received 3mg/kg lido-caine, Group 2 received 3mg/kg lidocaine plus 3mg atracurium, Group 3 received lidocaine 3mg/kg plus 5mg/kg atracurium, and group 4 received lidocaine 3mg/kg plus 10mg/kg atracu-rium. The sensory and motor blocks, tourniquet pain, the amount of administered intraoperative analgesics, patient and surgeon satisfaction, and side effects were analyzed in the groups using statistical tests. Results: The time for onset of sensory and motor blocks in group 2, group 3, and group 4 was significantly shorter than group1 (p<0.05). The total intraoperative pethidine was significant in the three studied groups when compared to the control group (p<0.05) it was less in group 2, group 3, and group 4 than in group 1. In terms of the recovery time of the sensory block, there were no significant differences between the control group and the other three studied groups. The tourniquet pain in groups 2, 3, and 4 was significantly lower than in group 1 (p<0.05). Motor recovery time was significantly more rapid in the control group in comparison to the other three groups (p<0.05). As regards the quality of anesthesia evaluated by the anesthesiologist and the surgeons it was significantly more satisfaction in group 3 and group 4 compared with group 2 and the control group (p<0.05). No significant difference was observed in the postoperative pain and the side effects of the lidocaine or the atracurium among the groups (p>0.05). Conclusion: The addition of different doses of atracurium to lidocaine for IVRA resulted in fast onset of sensory and motor block, a decrease in the severity of tourniquet pain, more satisfaction for the patients and surgeons without side effects from increasing atracurium doses.