Study of atracurium and tramadol or ketorolac as an adjunct to low dose lignocaine in intravenous regional anesthesia

Background: Purpose of the study was to evaluate the efficacy of Atracurium as adjuvant with tramadol or Ketorolac in reducing the dose of lignocaine used for intravenous regional anesthesia thereby decreasing the chances of systemic toxicity of lignocaine. Patients and Methods: The study was done in Department of Anaesthesia, Santhiram Medical College and General Hospital, Nandyal. 75 adult patients of ASA grade I and II were divided into three equal groups of twenty each in randomized double blind manner. Group I patients received 40ml of 0.5% lignocaine. Group II and III received 40 ml of 0.25% lignocaine with addition of 2 mg Atracurium and 50 mg tramadol while in Group III, tramadol was replaced with 30 mg of Ketorolac. Onset of sensory and motor block, intraoperative degree of analgesia, intraoperative and postoperative complications were recorded in all the three groups. Results: There was no significant difference between the groups with respect to age, weight and sex distribution. Mean time of onset of motor block in group I, II and III was statistically significant (p < 0.001). Mean time of onset of sensory block in groups I, II and III was also statistically significant. Intraoperative degree of analgesia in group II and III was comparable to group I. Conclusions: The use of 0.25% lignocaine and Atracurium with tramadol or Ketorolac provides comparable analgesia to 0.5% lignocaine used alone. This decreases the concentration and total dose of lignocaine required but delays the onset of both sensory and motor block.