Comparative study of ketorolac versus butorphanol as an adjuvant in Intravenous regional anaesthesia (IVRA)

  • Dr Amar Parkash Kataria MD Anaestheisa, Professor, Department of Anaesthesia, Government Medical College, Amritsar (Punjab), India-143001
  • Dr Joginder Pal Attri MD Anaestheisa, Associate Professor, Department of Anaesthesia, Government Medical College, Amritsar (Punjab), India-143001
  • Dr Nirvair Singh Junior Resident, Department of Anaesthesia, Government Medical College, Amritsar (Punjab), India-143001
  • Dr Millind Thakur Senior Resident, Department of Anaesthesia, Government Medical College, Amritsar (Punjab), India-143001
DOI: https://doi.org/10.17511/ijmrr.2016.i02.012
Keywords: Intravenous regional anaesthesia, Butorphanol, Ketorolac, Post-operative Pain

Abstract

Background: Intravenous regional anaesthesia (IVRA) is simple, effective technique for upper limb orthopaedic surgeries specifically in developing countries like India because of cost- effectiveness. IVRA is also called Bier’s block after the name of its inventor August Bier.

Aim: Present study was carried out to evaluate the effects of adding either butorphanol or ketorolac to lignocaine during Bier’s block.

Materials and Methods: In a prospective randomized double blind study, 60 patients of age group 18-65 years of either sex with weight range of 65-70 kg of ASA grade I- III were randomly allocated into two groups of 30 each. Group I received butorphanol 1mg added to 3mg/kg lignocaine and group II received ketorolac 30 mg added to 3mg/kg lignocaine. Sensory and motor block onset, regression time, intraoperative and postoperative VAS score, duration of analgesia, total analgesic consumption in first 24 hr and side effects were noted. Statistical analysis of data was based on chi square test and post hoc test.

Results: Demographic profile in both the groups was same. Duration of analgesia was significantly prolonged in group II(10.8 ±6.42) as compared to group I(3.02±1.52). In both the groups, patients remained haemodynamically stable and side effects and complications were also comparable.

Conclusion: Ketorolac with lignocaine in IVRA provides prolonged post-operative analgesia as compared to butorphanol and lesser number of patients require rescue analgesia intraoperatively as well as postoperatively without any significant side effects.

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References

1. Dos Reis A Jr. Intravenous regional anesthesia-first century (1908-2008). Beginning, development and current status. Rev Bras Anestesiol 2008 May-Jun;58(3):299-321.

2. Van Zundert A, Helmstadter A, Goerig M, Mortier E. Centennial of intravenous regional anesthesia. Bier’s Block. Reg Anesth Pain Med 2008 Sep-Oct;33(5):483-9. [PubMed]

3. Mohr B. Safety and effectiveness of intravenous regional anesthesia (Bier block) for outpatient management of forearm trauma. CJEM. 2006 Jul;8(4):247-50. [PubMed]

4. Vlassakov KV, Bhavani K. The forearm tourniquet Bier block. Logic and authority versus science and experience. Minerva Anestesiol 2010 Feb;76(2):91-2. [PubMed]

5. Reuben SS, Steinberg RB. Intravenous regional anaesthesia using lignocaine and ketorolac. Anesth Analg 1995; 81: 110-13. [PubMed]

6. Elhakim M, Sadek RA. Addition of atracurium to lidocaine for IVRA. Acta Anaesth Scand 1994; 38: 54-8. [PubMed]

7. Stoelting RK, Hillier SC. Pharmacology and Physiology in Anesthetic Practice: Cyclooxygenase-2 inhibitors, 4th edn. 2006, p. 282-8.

8. Rivera J, Villecon DJ, Dehner BK, Burkard JF, Osborne LA, Pellegrini JE. The efficacy of ketorolac as an adjunct to the bier block for controlling postoperative pain following nontraumatic hand and wrist surgery. AANA Journal 2008 Oct;76(5):341-5.

9. Stoelting RK, Hillier SC. Pharmacology and Physiology in Anesthetic Practice: Opioid agonist and antagonist, 4th edn. 2006, p. 282-8. [PubMed]

10. Myles PS, Urquhart N. The linearity of the visual analogue scale in patients with severe acute pain. Anaesth Intensive Care 2005;33:54–58. [PubMed]

11. Raja SN, Meyer RA, Campbell JN. Peripheral mechanisms of somatic pain. Anesthesiology 1988 Apr;68(4):571-90.

12. Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth 1989; 63:139-46. [PubMed]

13. Dahl JB, Kehlet H. Nonsteroidal anti-inflammatory drugs:rationale for use in severe postoperative pain. Br J Anaesth 1991 Jun;66(6):703-12.

14. Coleman MM, Peng PW, Regan JM, Chan VW, Hendler AL. Quantitative comparison of leakage under the tourniquet in forearm versus conventional intravenous regional anesthesia. Anesth Analg 1999; 89:1482–6.

15. Chilvers CR, Kinahan A, Vaghadia H, Merrick PM. Pharmaco-economics of intravenous regional anaesthesia vs general anaesthesia for outpatient hand surgery. Can J Anaesth 1997 Nov;44(11):1152-6. [PubMed]

16. Bansal A, Gupta S, Sood D, Kathuria S, Tewari A. Bier's block using lignocaine and butorphanol. J Anaesthesiol Clin Pharmacol 2011; 27:465-9. [PubMed]

17. Ko MJ, Lee JH, Cheong SH, Shin CM, Kim YJ, Choe YK et al Comparison of the effects of acetaminophen to ketorolac when added to lidocaine for intravenous regional anaesthesia. Korean J Anesthesiol 2010; 58:357-61. [PubMed]

18. Reuben SS, Steinberg RB. Intravenous regional anaesthesia using lignocaine and ketorolac. Anesth Analg 1995; 81:110-13.
Comparative study of ketorolac versus butorphanol as an adjuvant in Intravenous regional anaesthesia (IVRA)
CITATION
DOI: 10.17511/ijmrr.2016.i02.012
Published: 2016-02-29
How to Cite
1.
Kataria AP, Pal Attri J, Singh N, Thakur M. Comparative study of ketorolac versus butorphanol as an adjuvant in Intravenous regional anaesthesia (IVRA). Int J Med Res Rev [Internet]. 2016Feb.29 [cited 2024Dec.23];4(2):193-8. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/458
Issue
Vol 4 No 2 (2016): FEBRUARY
Section
Original Article

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