Anesth Pain Med.  2022 Jan;17(1):35-43. 10.17085/apm.21055.

Comparison of bolus administration effects of lidocaine on preventing tourniquet-induced hypertension in patients undergoing general anesthesia: a randomized controlled trial

• Kim JW
• Lee AR
• Park ES
• Yun MS
• Ryu SW
• Kim UG
• Kang DH
• Kim JD

• KMID: 2526525
• DOI: http://doi.org/10.17085/apm.21055

Abstract

Background
This study assessed the effect of a single bolus administration of lidocaine on the prevention of tourniquet-induced hypertension (TIH) and compared the effect of lidocaine to that of ketamine in patients undergoing general anesthesia.
Methods
This randomized, controlled, double-blind study included 75 patients who underwent lower limb surgery using a tourniquet. The patients were administered lidocaine (1.5 mg/kg, n = 25), ketamine (0.2 mg/kg, n = 25) or placebo (n = 25). The study drugs were administered intravenously 10 min before tourniquet inflation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured before tourniquet inflation, after tourniquet inflation for 60 min at 10 min intervals, and immediately after tourniquet deflation. The incidence of TIH, defined as an increase of 30% or more in SBP or DBP during tourniquet inflation, was also recorded.
Results
SBP, DBP, and HR increased significantly over time in the control group compared to those in the lidocaine and ketamine groups for 60 min after tourniquet inflation (P < 0.001, P < 0.001, and P = 0.007, respectively). The incidence of TIH was significantly lower in the lidocaine (n = 4, 16%) and ketamine (n = 3, 12%) group than in the control group (n = 14, 56%) (P = 0.001).
Conclusion
Single-bolus lidocaine effectively attenuated blood pressure increase due to tourniquet inflation, with an effect comparable to that of bolus ketamine.

Keyword

Hypertension; Ketamine; Lidocaine; Pain; Tourniquets

Figure

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  Fig. 1. Flowchart of the study participants.

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  Fig. 2. Changes in blood pressure in the three groups during anesthesia. (A) Systolic blood pressure (SBP), (B) diastolic blood pressure (DBP). There was a significant interaction between the three groups over time in SBP and DBP by repeated-measures analysis of variance and Bonferroni post-hoc test (all P < 0.001). T0: immediately before tourniquet inflation, T10–T60: every 10 min after tourniquet inflation, respectively, Toff: after tourniquet deflation. *P < 0.05 compared to the ketamine group. †P < 0.05 compared to the ketamine and lidocaine groups.

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  Fig. 3. Changes in heart rate (HR) in the three groups during anesthesia. There was a significant interaction in HR between the three groups over time by repeated-measures analysis of variance and Bonferroni post-hoc test (P < 0.001). T0: immediately before tourniquet inflation, T10–T60: every 10 min after tourniquet inflation, respectively, Toff: after tourniquet deflation.*P < 0.05 compared to the ketamine group.

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