الفهرس 
Venous and Nervous System of the Upper LimbOnly 14 pages are availabe for public view
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Abstract
IVRA is a safe anesthetic technique for upper or lower distal limb surgeries, it is a convenient alternative to general anesthesia in short operations where we avoid the risks and side effects of general anesthesia.
Analgesia and muscle relaxation are produced by the injection of an adequate local anesthetic solution into a distal peripheral vein of the extremity to be operated upon. The blood flow is prevented by a proximally applied pneumatic tourniquet.
However, IVRA have some limitations which include lack of postoperative analgesia, tourniquet pain and time limit to surgical procedure.
There are a number of studies in which non-steroidal analgesics were added to local anesthetics to modify these limitations based on their local anesthetic properties. Going through a number of studies we could understand that ketorolac is among the commonest additives to IVRA anesthetic solution.
Previous studies used magnesium for the treatment of chronic limb pain in IVRA and demonstrated that the addition of magnesium to lidocaine improves the quality of the block, extends the analgesia, and reduces the overall failure rate.
In our randomized, double blinded study, we compared the effect of ketorolac in the dose of 30 mg to the effect of 10 ml magnesium sulphate 10% when added to 40 ml of the anesthetic solution containing 3mg/kg of lidocaine used for IVRA in upper limb surgeries.
146 patients participated in our study, patients were allocated to two groups 73 patients in each group, a group of which received magnesium sulphate solution and the other received ketorolac solution.
We monitored the onset of sensory block and hemodynamic stability in each patient intra-operatively and post-operatively. In addition, we recorded the need for analgesics intra-operatively and post-operatively as well.
We found significantly lower intraoperative and postoperative NRS pain score within Ketorolac group as well as significantly less analgesic requirements compared to Magnesium sulphate group. There were no statistically significant differences regarding intraoperative hemodynamic changes between the two groups. However, magnesium sulphate showed faster onset for sensory block as compared to ketorolac.
So, we can reach to the conclusion from this study that although magnesium sulphate addition had the upper hand regarding the onset of sensory block, ketorolac addition showed better overall quality of anesthesia due to its intra-operative and prolonged post-operative analgesic effect.