Atracurium Mixed With Magnesium Sulfate Versus Atracurium Alone as Adjuvant to Lidocaine in IVRA
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 3

Summary: 
      The present clinical study will be undertaken to compare study between the effect of
      atracurium with lidocaine versus addition of magnesium sulphate to the same doses with
      lidocaine administrated alone in IntraVenous Regional Anaesthesia to access motor block,
      sensory block, tourniquet pain and post operative analgesia .Also assessment of patient and
      surgeon satisfaction .
    

Detailed description: 
      patients will be divided randomly into three groups (A, B, C) of 25 each, according to
      computer generated table of random numbers.

        -  Patients in group A will receive 3 mg/kg of lidocaine 2% diluted with saline to a total
           volume of 40 ml.

        -  Patients in group B receive 3 mg/kg of lidocaine 2% + 2 mg atracurium diluted with
           saline to a total volume of 40 ml.

        -  Patients in group C will receive 3 mg/kg of lidocaine 2% + 2 mg atracurium mixed with 10
           mg /kg magnesium sulphate diluted with saline to a total volume of 40 ml.

      Onset of sensory block will be assessed by a pin prick performed at 1 minute interval in the
      dermatomal sensory distribution of the medial and lateral ante brachial cutaneous, ulnar,
      median and radial nerves. Sensory block onset time will be recorded as time elapsed from
      injection of drug to sensory block achieved in all dermatomes.Onset of motor block will be
      assessed by asking the subject to flex and extend his/her wrist and fingers. Monitoring of
      motor block will be assessed by Modified Bromage Score . Complete motor block will be
      recorded when no voluntary movement will be possible.

      At the end of surgery, the tourniquet will be deflated by a cyclic deflation technique and
      recording this :

        -  Sensory block recovery time

        -  Motor block recovery time

        -  Mean arterial pressure (MAP),

        -  heart rate (HR)

        -  visual analogue scale (VAS) will be recorded at 0, 15 min , 1, 6, 12, and 24 h.

        -  The time to first analgesic requirement will be recorded (the time elapsed from
           tourniquet release until first patient request for analgesic).

      Patient and surgeon satisfaction
    

Intervention name(s): Lidocaine; atracurium; Mg sulphate
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Two intravenous cannulae will be placed; one in a vein on the dorsum of the hand to be operated (22 gauge) and the other in the opposite hand. A double tourniquet will be positioned on the upper arm of the hand to be operated. Arm will be elevated for 2 min.
Circulatory isolation of arm will be confirmed by inspection of the color of the limb, absence of radial pulse and loss of pulse oximetry tracing in the ipsilateral index finger. The upper (proximal) tourniquet will then be inflated to a pressure of 100 mmHg above the systolic blood pressure of the patient. The anesthetic solution will be prepared by an observer and will be given over a period of 90 seconds.; Two intravenous cannulae will be placed; one in a vein on the dorsum of the hand to be operated (22 gauge) and the other in the opposite hand. A double tourniquet will be positioned on the upper arm of the hand to be operated. Arm will be elevated for 2 min.
Circulatory isolation of arm will be confirmed by inspection of the color of the limb, absence of radial pulse and loss of pulse oximetry tracing in the ipsilateral index finger. The upper (proximal) tourniquet will then be inflated to a pressure of 100 mmHg above the systolic blood pressure of the patient. The anesthetic solution will be prepared by an observer and will be given over a period of 90 seconds.; Two intravenous cannulae will be placed; one in a vein on the dorsum of the hand to be operated (22 gauge) and the other in the opposite hand. A double tourniquet will be positioned on the upper arm of the hand to be operated. Arm will be elevated for 2 min.
Circulatory isolation of arm will be confirmed by inspection of the color of the limb, absence of radial pulse . The upper (proximal) tourniquet will then be inflated to a pressure of 100 mmHg above the systolic blood pressure of the patient. The anesthetic solution will be prepared by an observer and will be given over a period of 90 seconds.
Intervention MeSH terms: Lidocaine; Atracurium
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Diagnostic