تاثير افزودن بيكربنات به ليدوكايين بر زمان شروع بي دردي بلوك هماتوم براي جااندازي شكستگي كاليس

The effect of bicarbonate addition to Lidocaine in onset of analgesia in hematom for closed reduction of colles Fracture.

Background: The colles fracture is always accompanied by a severe pain when the physician tries to reduce it. Hematom block is one of the regional aesthetic techniques that used to anesthetize the patient.especialy in the population with age related problem that accompanies with high risk anaesthesia. Materials and methods: 80 patients 45-65yr old with ASA physical status I or III requesting hematom block were randomized into two groups, with or without bicarbonate addition to lidocaine in closed reduction of colles fracture, respectively. The patients were sedated with midazolam 0.15 mg/kg and fentanyl lmic/kg for both groups. In B group and A group the patient were anesthetized by 9 ml lidocaine 2% and 1ml bicarbonate 7.5% and 9 ml lidocaine 2% and 1ml water solution respectively. After alternative injection and aspiration into the fracture area, all samples were studied in terms of onset of anesthesia and its quantity of pain by visual analogue score (VAS ) before, during and thirty minutes after reduction. The data was gathered using a checklist and analyzed by SPSS software through descriptive statistics and Chi two paired T test & X2. Statistical significance requiredp < 0.05 (p <0.05). Results: The study showed that onset of analgesia in B group (H. block with bicarbonate) with (388.2± 63.8sec) and in groups A (H. block without bicarbonate) with (4o9.2±32.2sec) respectively (p=0.0001).VAS in the starting time of injection in B group with (7.9±1.9) and in A group (7.5±0.93) respectively (p=.069). Also, VAS during manipulation in B group was (1.4±0.75) and in A group (1.8±0.83) respectively (p=0.029). Eventually, thirty minutes later VAS scores of (4±0.81) in B group and in A group (4.7±0.88) respectively (p=0.001). Conclusion: Bicarbonate addition to lidocaine as an additive agent has a great effect on acceleration of anesthesia with reduction of post operative pain score. So hematoma-block with bicarbonate additive is recommended for this kind of fracture.