A new approach to intravenous regional anesthesia

In an attempt to reduce the dose of local anesthetic during intravenous (IV) regional anesthesia of the upper limb, we combined 100 mg of lidocaine with 0.05 mg of fentanyl and 0.5 mg of pancuronium. The study was designed in a randomized, double-blind fashion to determine the efficacy of this approach in providing analgesia and relaxation during surgery and to evaluate its safety after immediate deflation of the tourniquet following IV drug injection. Eighty unpremedicated patients, ASA physical status I or II, were assigned to the following groups: group A (n = 15) received 100 mg of lidocaine diluted in 40 mL of NaCl IV; groups B-D (n = 15 in each group) received 100 mg of lidocaine diluted in NaCl, with the addition of 0.05 mg of fentanyl (group B) or 0.5 mg of pancuronium (group C), or both (group D) to a total volume in all groups of 40 mL. Patients in groups A-D underwent elective operations on the forearm, wrist, and hand; for evaluation of safety, in 20 volunteers (group E) the tourniquet was immediately released after IV injection of the three drugs at the previously described doses. The analgesic effect was more profound in group D compared with groups A-C. In group D, 9 of 15 patients had excellent analgesia. In six patients, pain was experienced at the beginning of surgery, but 5 min thereafter patients remained pain free.(ABSTRACT TRUNCATED AT 250 WORDS)