Effect of adding 8 milligrams ondansetron to lidocaine for Bier's block on post-operative pain

Authors

Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Ondansetron has analgesic properties. The aim of the present study was to assess the analgesic effect of 8 mg ondansetron when added to lidocaine for intravenous regional anesthesia (IVRA).
Materials and Methods: Ninety patients undergoing hand surgery were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL (Group L, n = 30) or 8 mg ondansetron plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL (group LO, n = 30) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL plus 8 mg ondansetron intravenously (Group IO, n = 30). Tourniquet pain and analgesic use were recorded before and after the tourniquet application.
Results: The sensory and motor block onset times were significantly shorter in Group LO compared with Group L and Group IO (4.2 ± 1.7 vs. 5.2 ± 0.8 and 5.1 ± 1.2 respectively, P < 0.05; 4.5 ± 1.4 vs. 5.8 ± 1.5 and 5.7 ± 1.4 respectively, P < 0.05). The sensory and motor block recovery times were significantly longer in Group LO compared with Group L and Group IO (6.1 ± 1.1 vs. 4.1 ± 1.3 and 4.5 ± 0.9 respectively, P < 0.05; 6.7 ± 1.4 vs. 4.4 ± 0.9 and 4.7 ± 0.7 respectively, P < 0.05). Post-operative VAS scores were significantly less in Group LO compared with Group L and Group IO till 24 h after tourniquet deflation ( P < 0.05).
Conclusion: The addition of 8 mg ondansetron to lidocaine for IVRA reduced intraoperative and post-operative analgesic use till 24 h.

Keywords

1. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedure. Can J Anaesth 2002;49:32-45.  Back to cited text no. 1
[PUBMED]    
2. Yurtlu S, Hanci V, Kargi E, Erdoðan G, Köksal BG, Gül Þ, et al. The analgesic effect of dexketoprofen when added to lidocaine for intravenous regional anaesthesia: A prospective, randomized, placebo-controlled study. J Int Med Res 2011;39:1923-31.  Back to cited text no. 2
    
3. Sørensen AM, Dalsgaard J, Hansen TB. Local anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: A randomized controlled trial. J Hand Surg Eur Vol 2012. [In Press].  Back to cited text no. 3
    
4. Memis D, Turan A, Karamanlioglu B, Pamukcu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anaesthesia. Anesth Analg 2004;98:835-40.  Back to cited text no. 4
    
5. Esmaoglu A, Akin A, Mizrak A, Turk Y, Boyaci A. Addition of cisatracurium to lidocaine for intravenous regional anesthesia. J Clin Anesth 2006;18:194-7.  Back to cited text no. 5
[PUBMED]    
6. Tramèr MR, Reynolds DJ, Stoner NS, Moore RA, McQuay HJ. Efficacy of 5-HT3 receptor antagonists in radiotherapy-induced nausea and vomiting: A quantitative systematic review. Eur J Cancer 1998;34:1836-44.  Back to cited text no. 6
    
7. Glaum SR, Proudfit HK, Anderson EG. Reversal of the antinociceptive effects of intrathecally administered serotonin in the rat by a selective 5-HT3 receptor antagonist. Neurosci Lett 1988;19:313-7.  Back to cited text no. 7
    
8. Ye JH, Mui WC, Ren J, Hunt EE. Ondansetron exhibits the Properties of a local anesthetic. Anesth Analg 1997;85:1116-21.  Back to cited text no. 8
    
9. Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting. A comparison of their pharmacology and clinical efficacy. Drugs 1998;55:173-89.  Back to cited text no. 9
[PUBMED]    
10. Farouk S. Ondansetron added to lidocaine for intravenous regional anaesthesia. Eur J Anaesthesiol 2009;26:1032-6.  Back to cited text no. 10
[PUBMED]    
11. Raj PP, Garcia CE, Burleson JW, Jenkins MT. The site of action of intravenous regional anesthesia. Anesth Analg 1972;51:776-86.  Back to cited text no. 11
[PUBMED]    
12. Rosenberg PH. Intravenous regional anesthesia: Nerve block by multiple mechanisms. Reg Anesth 1993;18:1-5.  Back to cited text no. 12
    
13. Deegan R. Ondansetron: Pharmacology of a specific 5HT3-receptor antagonist. Am J Med Sci 1992;304:373-8.  Back to cited text no. 13
[PUBMED]    
14. Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: A randomized, controlled, double-blinded study. Anesth Analg 1999;89:197-9.  Back to cited text no. 14
[PUBMED]    
15. Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: A randomised, double-blind controlled comparison with lidocaine. Anaesthesia 2001;56:902-5.  Back to cited text no. 15
[PUBMED]    
16. Richardson BP, Bucheit KH. The pharmacology, distribution and function of 5-HT3 receptors. In: Osborne NN, Hamon M, editors. Neuronal serotonin. Chichester: John Wiley and Sons; 1988. p. 465-506.  Back to cited text no. 16
    
17. Kidd EJ, Laporte AM, Langlois X, Fattaccini CM, Doyen C, Lombard MC, et al. 5-HT3 receptors in the rat central nervous system are mainly located on nerve fibres and terminals. Brain Res 1993;612:289-98.  Back to cited text no. 17
[PUBMED]    
18. Fassoulaki A, Melemeni A, Zotou M, Sarantopoulos C. Systemic ondansetron antagonizes the sensory block produced by intrathecal lidocaine. Anesth Analg 2005;100:1817-21.  Back to cited text no. 18
[PUBMED]    
19. Cui M, Feng Y, McAdoo DJ, Willis WD. Periaqueductal gray stimulation-induced inhibition of nociceptive dorsal horn neurons in rats is associated with the release of norepinephrine, serotonin, and amino acids. J Pharmacol Exp Ther 1999;289:868-76.  Back to cited text no. 19
[PUBMED]    
20. Arcioni R, della Rocca M, Romanò S, Romano R, Pietropaoli P, Gasparetto A. Ondansetron inhibits the analgesic effects of tramadol: A possible 5-HT (3) spinal receptor involvement in acute pain in humans. Anesth Analg 2002;94:1553-7.  Back to cited text no. 20
    
21. Murphy RM, Zemlan FP. Selective serotonin 1A/1B agonists differentially affect spinal nociceptive reflexes. Neuropharmacology 1990;29:463-8.  Back to cited text no. 21
[PUBMED]    
22. Alhaider AA, Lei SZ, Wilcox GL. Spinal 5-HT3 receptor-mediated antinociception: Possible release of GABA. J Neurosci 1991;11:1881-8.  Back to cited text no. 22
[PUBMED]    
23. Zeitz KP, Guy N, Malmberg AB, Dirajlal S, Martin WJ, Sun L, et al. The 5-HT3 subtype of serotonin receptor contributes to nociceptive processing via a novel subset of myelinated and unmyelinated nociceptors. J Neurosci 2002;22:1010-9.  Back to cited text no. 23
[PUBMED]    
24. Stratz T, Müller W. The use of 5-HT3 receptor antagonists in various rheumatic diseases-a clue to the mechanism of action of these agents in fibromyalgia. Scand J Rheumatol Suppl 2000;113:66-71.  Back to cited text no. 24
    
25. Färber L, Stratz TH, Brückle W, Späth M, Pongratz D, Lautenschläger J, et al. German Fibromyalgia Study Group. Short-term treatment of primary fibromyalgia with the 5-HT3-receptor antagonist tropisetron. Results of a randomized, double-blind, placebo-controlled multicenter trial in 418 patients. Int J Clin Pharmacol Res 2001;21:1-13.  Back to cited text no. 25
    
26. Färber L, Stratz T, Brückle W, Späth M, Pongratz D, Lautenschläger J, et al. Efficacy and tolerability of tropisetron in primary fibromyalgia-a highly selective and competitive 5-HT3 receptor antagonist. German Fibromyalgia Study Group. Scand J Rheumatol Suppl 2000;113:49-54.  Back to cited text no. 26
    
27. Camilleri M, Mayer EA, Drossman DA, Heath A, Dukes GE, McSorley D, et al. Improvement in pain and bowel function in female irritable bowel patients with alosetron, a 5-HT3 receptor antagonist. Aliment Pharmacol Ther 1999;13:1149-59.  Back to cited text no. 27
[PUBMED]    
28. Müller W, Fiebich BL, Stratz T. 5-HT3 receptor antagonist als analgetics in rheumatic diseases. Z Rheumatol 2006;65:546, 548-52.  Back to cited text no. 28
    
29. Gielen MJ, Stienstra R. Tourniquet hypertension and its prevention: A review. Reg Anesth 1991;16:191-4.  Back to cited text no. 29
[PUBMED]    
30. McCleane GJ, Suzuki R, Dickenson AH. Does a single intravenous injection of the 5HT3 receptor antagonist ondansetron have an analgesic effect in neuropathic pain? A double-blinded, placebo-controlled cross-over study. Anesth Analg 2003;97:1474-8.  Back to cited text no. 30
[PUBMED]    
31. Wolf H. Preclinical and clinical pharmacology of the 5-HT3 receptor antagonists. Scand J Rheumatol Suppl 2000;113:37-45.  Back to cited text no. 31
[PUBMED]    
32. Reuben SS, Steinberg RB, Lurie SD, Gibson CS. A dose-response study of intravenous regional anesthesia with meperidine. Anesth Analg 1999;88:831-5.  Back to cited text no. 32
[PUBMED]    
33. Gentili M, Bernard JM, Bonnet F. Adding clonidine to lidocaine for intravenous regional anesthesia prevents tourniquet pain. Anesth Analg 1999;88:1327-30.  Back to cited text no. 33
[PUBMED]    
34. De Marzo C, Crovace A, De Monte V, Grimaldi D, Iarussi F, Staffieri F. Comparison of intra-operative analgesia provided by intravenous regional anesthesia or brachial plexus block for pancarpal arthrodesis in dogs. Res Vet Sci 2012.  Back to cited text no. 34
    
35. Honarmand A, Safavi M, Fatemy A. The analgesic effect of three different doses of nitroglycerine when added to lidocaine for intravenous regional anesthesia in trauma patients. Ulus Travma Acil Cerrahi Derg 2011;17:497-503.  Back to cited text no. 35
[PUBMED]