Dr.A.GOWRISHANKAR . PG DEPT OF ANESTHESIOLOGY THANJAVUR MEDICAL COLLEGE

1. COMPARATIVE STUDY OF 0.5% LIDOCAINE AND 0.2% ROPIVACAINE IN INTRAVENOUS REGIONAL ANAESTHESIA FOR HAND SURGERIES Dr.A.GOWRISHANKAR. PG DEPT OF ANESTHESIOLOGY THANJAVUR MEDICAL COLLEGE

2. To compare the anaesthetic efficacy, post-operative analgesia, side-effects between lidocaine 0.5%and ropivacaine 0.2% when intravenous regional anesthesia was used in hand surgeries

3. METHODS AND MATERIALS • Approval from institutional ethical committee and written consent from the patient • 40 adult patients ASA I , II • Pts allocated into two groups (Randomised control study) Group I : (n=20) : Lidocaine 0.5% (3 mg/kg) Group II : (n=20) : Ropivacaine 0.2% (1.2 mg/kg) • elective and emergency hand surgeries lasting less than one hour

4. EXCLUSION CRITERIA • ASA III ,IV • Liver and renal disease • Sickle cell disease • Cardiac conduction abnormalities • Neurological & vascular abnormalities • Uncontrolled hypertension • Diabetic neuropathy • Pregnancy • h/o seizure

5. Fasting guidelines were followed • 18 g iv cannula on non operative side • 20 g iv cannula was inserted in the distal vein on the dorsum of the hand of the operative extremity • Baseline PR,BP ,SPO2 ,RR were recorded. • Exsanguination with esmarch bandage • Circulation was occluded by the proximal cuff of a double cuffed pneumatic tourniquet • Distal cuff inflated and proximal cuff deflated when VNPRS > 5 • After completion of surgery tourniquet deflated in biphasic manner.

6. MONITORING • Tourniquet inflation and deflation time. • Onset of sensory and motor blockade. • Intra-op hemodynamics. • Intra-op tourniquet pain. • Sensory and motor recovery time. • Duration of post –op analgesia. • Total dose of rescue analgesics. • complication.

7. sex No of patients

8. DIAGNOSIS • No of patients

9. ONSET OF SENSORY ANALGESIA

10. ONSET OF MOTOR BLOCKADEIndependent samples test

11. VNPS 20 MIN No of patients VNPS P (<0.05)

12. VNPS 40 MIN No of patients VNPS (P<0.05)

13. SENSORY REGRESSIONIndependent samples test

14. MOTOR REGRESSIONIndependent samples test

15. POST OP ANALGESIAIndependent samples test

16. Post op analgesic doseChi-square test

17. POST OP ANALGESIC DOSE REQUIREMENT

18. No of patients complications • Metallic taste • Light headedness • Nausea • Tinnitus • seizure

19. CONCLUSION • We conclude that ropivacaine 0.2% provides prolonged analgesia, lower post-op rescue analgesics requirement, and lesser side effects and hence an alternative to lidocaine 0.5% in Intravenous regional anesthesia for hand surgeries.

20. Literature search …… • Anesthesia and Analgesia 1999 :89 (727-31): yale university of medicine, New haven ,Connecticut • Clinical anesthesia 2009 dec 21 vol :8 • Thomas Jefferson university , Anesthesiology june 1999- vol 90 Issue 6 • Cukurova university faculty of medicine,adana turkey • Pubmed.2002 nov-dec :27 (6) : 595-9 • Toronto western hospital university of Toronto ,Toronto ,Ontario ,Canada • Actaanesthesiologicascandinavica vol:48 issue 1 • Canadian journal of anesthesia/springer New York vol:49, num 2 /feb ,2002

21. Thank u………