| Abstract|| |
Background: The increasing use of regional anesthesia and peripheral nervous blocks and also local anesthetic effects of meperidine, made us adding this drug to lidocaine-induced axillary block for patients undergoing upper extremities surgery to measure its effects and especially block length time. Objective: The aim of this study is effect survey of meperidine on lidocaine-induced axillary block in patients undergoing upper extremities surgery. Materials and Methods: This randomized double-blinded clinical trial was conducted on consecutive forty patients aged between 15 and 56 years, rated as the American Society of Anesthesiology I-II who were scheduled for upper extremities surgery. The study protocol was approved by the ethics committee at Kermanshah University of Medical Sciences. These 40 patients divided into two groups which were similar in terms of age, gender, and weight. The patients were randomly assigned to receive one of the two following protocols for axillary block: (1) 40 ml lidocaine 1% plus 0.01 ml/kg normal saline and (2) 40 ml lidocaine 1% plus 0.01 ml/kg equaling 1 mg/kg meperidine. The blocking method was similar in both groups (Ultrasound-Guided Axillary block). The analysis was done with Chi-square and Fisher's exact test for complications and t-test for quantitative variables in both groups. Results: Both two groups were similar in terms of block onset time, the intensity of analgesia block and side effects such as nausea, vomiting, hypotension, dizziness, arrhythmia, and convulsion. The obtained results from this study suggest that meperidine added to lidocaine-induced axillary block prolongs the duration of blocked (238 ± 67.04 vs. 166.7 ± 39.6) which is statistically significant (P < 0.001). Conclusion: According to the study findings, the axillary block onset time was not statistically different between two groups. Totally adding meperidine to lidocaine-induced axillary block did not lead to increase the systemic side effects, but prolonged duration of blockade significantly. It is suggested to use this method for prolonged surgeries especially in emergency patients with contraindication for general anesthesia and also for general populations who have short time upper extremity surgery and also to provide a long-term postoperation analgesia.
Keywords: Axillary block, lidocaine, meperidine, upper extremity surgery
|How to cite this article:|
Hemmati N, Zokaei A, Ahmadi SJ. The effect of meperidine on lidocaine-induced axillary block in patients undergoing upper extremities surgery. Ann Trop Med Public Health 2017;10:1533-6
|How to cite this URL:|
Hemmati N, Zokaei A, Ahmadi SJ. The effect of meperidine on lidocaine-induced axillary block in patients undergoing upper extremities surgery. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Nov 15];10:1533-6. Available from: http://www.atmph.org/text.asp?2017/10/6/1533/222664
| Introduction|| |
Nowadays, the use of general anesthesia for upper and lower extremities surgery has been largely replaced with peripheral blocks. The reason for this issue is avoidance of general anesthesia risks and better postoperation pain control.
It is common to use long-acting local anesthetic drugs for prolonged surgeries and also long-term postoperation pain control and the adjuvant drugs have been used to prolong the duration of local anesthetic-induced block. Using long-acting local anesthetics in combination with vasoconstrictor drugs result in tingling, numbness, and also long-term motor blocking which in addition to unpleasant feeling for the patient, disturb the special examination results postsurgery. Local surgical procedures date back to 1880. In previous studies, there were contradictory evidence such as the effects of adding morphine to Brachial plexus block to prolong the duration of blockade which results in success or failure., In one study, adding fentanyl has been associated with accelerated analgesia onset time but did not change the duration of analgesia. In another study, the block onset time has been delayed but duration of blockade prolonged with this drug. In previous studies, the effects of added narcotic drugs to the local anesthetic solutions for major blocking have been explained according to three mechanisms:,
- The effect on the peripheral receptors
- Transferring the drug molecules through nerve sheath to the extradual and subarachnoid spaces and banding to receptors in posterior horn of the spinal cord
- Transmission through nerve axons to the spinal cord gelatinous substance.
Most of the previous studies have been used partial agonist opioids. Meperidine is a narcotic drug which is easily available for anesthesiologists. It is a drug with local anesthetic effects which in addition to the effect on opioid receptors it can have local anesthetic properties in periphery.
Due to its safety, easiness of block and also providing proper local anesthesia in axillary block, we performed this research to investigate the time duration of blockade, block onset time and also the rate of systemic complications, using meperidine in lidocaine-induced axillary block. We suggest to use this method for prolonged surgeries, especially in emergency patients with contraindication for general anesthesia and also for general populations who have short time upper extremity surgery and also to provide a long-term postoperation analgesia.
| Materials and Methods|| |
This randomized double-blinded clinical trial was conducted on consecutive forty patients aged between 15 and 56 years, rated as the American Society of Anesthesiology I–II who were scheduled for upper extremities surgery (soft tissue of elbow, forearm, and hand).
The patients were randomly assigned to receive one of the two following protocols for axillary block: (1) 40 ml lidocaine 1% plus 0.01 ml/kg normal saline and (2) 40 ml lidocaine 1% plus 0.01 ml/kg equaling 1 mg/kg meperidine. The study protocol was approved by the ethics committee at Kermanshah University of Medical Sciences.
According to definition by the American Society of Anesthesiologists, class I refers to healthy control without organic, biochemical or psychiatric disease and class II refers to the individuals with mild systemic disease (mild asthma or well-controlled Hypertension. No significant impact on daily activity. Unlikely to have an impact on anesthesia and surgery). The patients addicted to narcotic drugs and also the patients who were unable to communicate due to language problems or inability to understand of study detail were excluded from the study. The time duration of surgery for two groups was <1 h.
After preparing appropriate intravenous line in opposite upper limb, performing cardiac monitoring and measuring blood pressure, axillary block was conducted in the same way in two groups (ultrasound-guided axillary block); The patients were randomly assigned to receive one of the two following protocols for axillary block: group one) 40 ml lidocaine 1% (vial 50 cc 1% made in Pasteur Institute of Iran) plus 0.01 ml/kg normal saline and group two) 40 ml lidocaine 1% (the same as group one) plus 0.01 ml/kg equaling 1 mg/kg meperidine (meperidine ampoule 100 mg made in Jerot Vien Factory).
Then, the indexes of block onset time (intervals between end of injection and appearing the symptoms of analgesia) in terms of minute, pain intensity by use of visual analog scale in terms of numerical scale (in three times in 5th, 10th, and 15th min after block), the time duration of blockade (the time between starting block and patient requesting for first dose of narcotic) in terms of minute and also appearing the systemic complications such as nausea, vomiting, dizziness, convulsion, cardiac arrhythmia, and hypotension (decreasing the mean blood pressure more than 30% of basic scale) were recorded in a pre-prepared checklist by a person who did not have knowledge about the prescribed drugs.
At the end, the collected data were tested and compared in both groups using Chi-square and Fisher's exact test for complications and t-test for the quantitative parameter.
| Results|| |
Both groups were similar in terms of age, gender, and weight [Table 1]. Side effects such as vomiting, convulsion, and arrhythmia were not observed in any groups, and other side effects (nausea, dizziness, and hypotension) in both groups were not statistically different [Table 2].
The value of block onset time, pain level in the 5th, 10th, and 15th min, visual analog scale (VAS) score in the 10th min compared to the 15th min, and VAS score in 15th min compared to the 10th min were not statistically different [Table 3]. Only the duration of the blockade, in group one was 166.7 ± 36.6 min and in group two was 238.4 ± 67.04 min, and this difference was statistically significant (P < 0.001).
| Discussion|| |
In this study, block onset time has not been changed and totally adding meperidine to lidocaine-induced axillary block has prolonged duration of blockade properly without increasing systemic complications. Previous studies have been shown enhancement of block time by adding the narcotic drugs such as butorphanol, fentanyl, and buprenorphine., In two studies, adding fentanyl has prolonged duration of blockade , and in another study, it accelerated block onset time but was ineffective to prolong the duration of blockade.
In case of morphine, it increased the time duration of axillary blockade successfully, but in the other study, they could not prove this effect.
In one study, the results suggested the prolongation of block time duration to 3 times in group which have been blocked with local anesthetic and buprenorphine compared with observing group, and in a group that the narcotic drug was just prescribed intramuscularly at the same time of local anesthetic-induced block, the duration of analgesia was 2 times more than observing group.
In Iran, most studies have been done on Bier intravenous block  and the effect of adding meperidine on this block has been measured, and of course, the given block is more dangerous than axillary block, but the obtained results suggest the prolongation of block time and improving the quality of analgesia. At the end, we suggest to add meperidine to lidocaine-induced Axillary Block in patients undergoing upper extremities surgery for prolonged surgeries, especially in emergency patients with contraindication for general anesthesia and also for general populations who have short time upper extremity surgery and also to provide a long-term postoperation analgesia.
| Conclusion|| |
According to the study findings, the axillary block onset time was not statistically different between two groups. Totally adding meperidine to lidocaine-induced axillary block did not lead to increase the systemic side effects, but prolonged duration of blockade significantly. It is suggested to use this method for prolonged surgeries especially in emergency patients with contraindication for general anesthesia and also for general populations who have short time upper extremity surgery and also to provide a long-term postoperation analgesia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Patil S, Debata D, Doshi C, Vyas V, Sinha S. Effect of buprenorphine as an adjunct with plain local anesthetic solution in supraclavicular brachial plexus block on quality and duration of postoperative analgesia. J Anaesthesiol Clin Pharmacol 2015;31:496-500.
] [Full text]
Saryazdi H, Yazdani A, Sajedi P, Aghadavoudi O. Comparative evaluation of adding different opiates (morphine, meperidine, buprenorphine, or fentanyl) to lidocaine in duration and quality of axillary brachial plexus block. Adv Biomed Res 2015;4:232.
] [Full text]
Kardash K, Schools A, Concepcion M. Effects of brachial plexus fentanyl on supraclavicular block. A randomized, double-blind study. Reg Anesth 1995;20:311-5.
Dayioǧlu H, Baykara ZN, Salbes A, Solak M, Toker K. Effects of adding magnesium to bupivacaine and fentanyl for spinal anesthesia in knee arthroscopy. J Anesth 2009;23:19-25.
Chopra P, Talwar V. Low dose intrathecal clonidine and fentanyl added to hyperbaric bupivacaine prolongs analgesia in gynecological surgery. J Anaesthesiol Clin Pharmacol 2014;30:233-7.
] [Full text]
Chen F, Xiong H, Yang J, Fang B, Zhu J, Zhou B, et al.
Butorphanol and ketamine combined in infusion solutions for patient-controlled analgesia administration: A long-term stability study. Med Sci Monit 2015;21:1138-45.
Chen FC, Shi XY, Li P, Yang JG, Zhou BH. Stability of butorphanol-tropisetron mixtures in 0.9% sodium chloride injection for patient-controlled analgesia use. Medicine (Baltimore) 2015;94:e432.
Sousa AM, Ashmawi HA. Local analgesic effect of tramadol is not mediated by opioid receptors in early postoperative pain in rats. Braz J Anesthesiol 2015;65:186-90.
Miller RD, Pardo M. Basics of Anesthesia. Philadelphia: Elsevier Health Sciences; 2011.
Taylor PM, Hoare HR, de Vries A, Love EJ, Coumbe KM, White KL, et al.
multicentre, prospective, randomised, blinded clinical trial to compare some perioperative effects of buprenorphine or butorphanol premedication before equine elective general anaesthesia and surgery. Equine Vet J 2016;48:442-50.
Moon JY, Choi SS, Lee SY, Lee MK, Kim JE, Lee JE, et al.
The effect of nefopam on postoperative fentanyl consumption: A Randomized, double-blind study. Korean J Pain 2016;29:110-8.
Kosel J, Bobik P, Siemiątkowski A. Buprenorphine added to bupivacaine prolongs femoral nerve block duration and improves analgesia in patients undergoing primary total knee arthroplasty-a randomised prospective double-blind study. J Arthroplasty 2015;30:320-4.
Kasaba T. Some adjuvants added to local anesthetics improve the duration and quality of epidural anesthesia. Masui 2010;59 Suppl:S157-65.
Basuni AS. Addition of low-dose ketamine to midazolam and low-dose bupivacaine improves hemodynamics and postoperative analgesia during spinal anesthesia for cesarean section. J Anaesthesiol Clin Pharmacol 2016;32:44-8.
] [Full text]
Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al.
Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block. Can J Anaesth 2012;59:21-7.
Wajima Z, Shitara T, Nakajima Y, Kim C, Kobayashi N, Kadotani H, et al.
Continuous brachial plexus infusion of butorphanol-mepivacaine mixtures for analgesia after upper extremity surgery. Br J Anaesth 1997;78:83-5.
Flory N, Van-Gessel E, Donald F, Hoffmeyer P, Gamulin Z. Does the addition of morphine to brachial plexus block improve analgesia after shoulder surgery? Br J Anaesth 1995;75:23-6.
Ziapour A, Zokaei A, Kahrizy A. A theoretical study of the standing of social investment in the health sector. Soc Sci 2016;11:3682-7.
Honarmand A, Safavi M, Nemati K, Oghab P. The efficacy of different doses of midazolam added to lidocaine for upper extremity bier block on the sensory and motor block characteristics and postoperative pain. J Res Pharm Pract 2015;4:160-6.
] [Full text]
School of Medicine, Kermanshah University of Medical Sciences, Kermanshah
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]