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Indian Journal of Anesthesia and Analgesia

Volume  5, Issue 7, July 2018, Pages 1120-1123


Original Article

Efficacy of Nitroglycerine and Dexamethasone with Lignocaine in Bier’s Block for Upper Limb Surgery
Ajai Vikram Singh
Associate Professor, Department of Anesthesiology & Critical Care, Veer Chandra Singh Garhwali Government Institute Of Medical Science and Research (VCSGGMSRI), Srinagar (Garhwal), Uttarakhand 246174, India.
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This study was done to evaluate the efficacy of nitroglycerine and dexamethasone as adjuncts to lignocaine in the terms of onset, duration, quality and efficacy of IVRA (Bier’s block). This study was done on randomly selected 90 adult patients of either sex belonging to ASA grade I & II, aged 20 to 60 years undergoing for upper limb surgery duration lasting not more than 90 mins in three groups. Group 1- Plain lignocaine 2% diluted with saline (40ml), Group 2- lignocaine 2% and nitroglycerine, (40ml) Group 3- lignocaine 2% and dexamethasone (40ml). Patients were premedicated with 0.05mg/kg midazolam 5 minutes prior to surgical procedure. Basal vitals were monitored in all the patients. Two venous cannulae were placed, with all aseptic measures, one in dorsum of the operating hand and the other in the opposite hand for intravenous fluid infusion. Operative hand was exsanguinated with an esmarch bandage to squeeze the circulating blood, a double cuffed pneumatic tourniquet was placed around the upper arm and proximal cuff was inflated to 250mm Hg. Regional anaesthesia was injected slowly. Sensory block was assessed by pin prick cutaneous test. Onset of motor block was noted by asking the subject to flex and extent his/her wrist and fingers. As the sensory and motor block was achieved, distal cuff was inflated and the proximal cuff was released and surgery was started. Tourniquet pain was assessed using Visual Analogue Scale. The mean duration of surgery in group 1 was was 44.0±10.5 minutes, in Group2 was 41.2±9.7 minutes and Group3 was 43.3±9 minutes. The addition of 200µgm nitroglycerine improved the speed of onset, quality of anaesthesia, prolonged the sensory and motor block recovery time, increase the duration of post-operative analgesia. The addition of 8mg dexamethasone improved the quality of anaesthesia but did not cause significant difference in time. According to this study, it can be assumed that the addition of nitroglycerine and dexamethasone to lignocaine in Intravenous Regional Analgesia definitely improved the quality of anaesthesia.

Keywords: Intravenous Regional Analesia; Double Cuff Pneumatic Tourniquet; Esmarch Bandage; Lignocaine; Nitroglycerine; Dexamethasone.


Corresponding Author : Ajai Vikram Singh, Associate Professor, Department of Anesthesiology & Critical Care, Veer Chandra Singh Garhwali Government Institute of Medical Science and Research (VCSGGMSRI), Srinagar (Garhwal), Uttarakhand 246174, India.