Korean J Anesthesiol Ko, et al. (VAS) (0 = no pain and 10 = worst pain imaginable) were moni- tored at 5, 10, 20, 30 and 40 min after tourniquet application. Results Intermittent bolus of 1 μg/kg fentanyl were administrated for Sensory block onset time was significantly shorter in Group P tourniquet pain treatment when VAS > 3. The onset time of than in group C (P < 0.05). There was no significant difference tourniquet pain time was recorded (the time elapsed after among groups when compared for sensory block recovery time tourniquet inflation to first patient reported VAS > 3). The total (Table 3). fentanyl consumption for maintaining VAS below 3 was also There was no significance among groups for intraoperative recorded. During operation if there was no tourniquet pain total amount of fentanyl consumption (P = 0.093). The number more than VAS 3, tourniquet pain onset time was accepted as of patients who required fentanyl were eleven in Group C, eight the duration of tourniquet application time. The tourniquet was not deflated within 40 min and was in Group P, thirteen in Group C. Tourniquet pain onset time was significantly longer in Group P than other groups (P < 0.05) not inflated more than 1.5 hours. At the end of surgery, the (Table 3). tourniquet deflation was performed by the cyclic deflation There was no significant difference among groups when technique (the tourniquet was deflated three times in a cyclic compared against VAS scores for tourniquet pain (Table 4). manner with 10 second periods of deflation separated by 1 Postoperative VAS score in Group P and Group K were signifi- minute periods of reinflation). Sensory recovery time was noted cantly lower than Group C (P < 0.001) (Table 4). Twelve patients (time elapsed after tourniquet deflation up to recovery of pain of Group C were given additional analgesic (tramadol 50 mg) in all dermatomes determined by pinprick test). in postanesthesia care unit, whereas four patients of Group Assessment of postoperative surgical pain scores using VAS P and only one patient of Group K were given tramadol. The were checked every 30 min after tourniquet deflation for 2 postoperative analgesic consumption was significantly lower in hours in postanesthesia care unit and highest VAS of each Group P and Group K than group C (P < 0.001) (Table 4). patient was noted as postoperative VAS score. In postanesthesia No patient developed hypotension, hypoxemia, bradycardia care unit, patient received tramadol 50 mg when VAS was > 3, or any other adverse events in intraoperative and postoperative and total amounts of tramadol administered to each group were period over a period of 24 hours in ward. recorded. in the ward. During the intraoperative period and postoperative period, any local or systemic complications were recorded for 24 hours Discussion The primary outcome of this study was - addition of intravenous Statistical analysis was performed with MedcalcTM for acetaminophen to lidocaine for IVRA decreased onset time windows version 9.1 (Frank schoonjans, Belgium). Comparison of sensory block, postoperative pain, postoperative analgesic among the groups was made with one-way analysis of variance (ANOVA). Significance was assumed at P < 0.05. Table 3. Onset and Recovery Time of Sensory Block, Tourniquet Pain Onset Time, Intraoperative Fentanyl Consumption and Number of Patients who Required Fentanyl Group C (n = 20) Group P (n = 20) Group K (n = 20) Sensory block Onset time (min) 3.6 ± 1.6 2.3 ± 1.4* 3.1 ± 1.4 Recovery time (min) 3.0 ± 2.0 2.6 ± 1.0 3.2 ± 1.8 Tourniquet pain onset time (min) 26.4 ± 10.7 34.6 ± 7.8* 28.6 ± 10.8 Intraoperative fentanyl consumption (μg) 35.3 ± 33.1 22 ± 28.7 42 ± 33.2 Patients who required fentanyl (n) 11 8 13 Values are number of patients or mean ± SD. Group Creceived 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml for IVRA. Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml. Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketololac 10 mg to a total volume of 40 ml. *P < 0.05 compared with Group C. www.ekja.org Table 4. VAS Scores after Tourniquet Inflation, Postoperative VAS Scores, Tramadol Consumption and Number of Patients who Re- quired Tramadol VAS scores after tourniquet inflation 5 min 10 min 20 min 30 min 40 min Postoperative VAS scores Postoperative tramadol consumption (mg) Patients who required tramadol (n) Group C (n = 20) 1.4 ± 1.3 1.8 ± 1.6 2.7 ± 2.1 3.1 ± 4.4 4.3 ± 2.5 3.8 ± 2.4 Group P (n = 20) Group K (n = 20) 0.9 ± 1.2 1.2 ± 1.3 2.2 ± 1.6 3.0 ± 1.8 4.5 ± 2.3 2.2 ± 1.6* 1.3 ± 1.3 2.0 ± 1.6 3.4 ± 2.3 3.5 ± 1.8 4.2 ± 1.7 1.4 ± 1.2* 30.0 ± 25.1 10.0 ± 20.5* 2.5 ± 11.2* 12 4* 1* Values are number of patients or mean ± SD. Group Creceived 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml for IVRA. Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml. Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketololac 10 mg to a total volume of 40 ml. *P < 0.05 compared with Group C. 359