Magnesium Sulfate versus Tramadol as Adjuvants to Lidocaine in Intravenous Regional Anesthesia for Carpal Tunnel Release Surgery: A Randomized Clinical Study

Background: Intravenous regional anesthesia [IVRA] is a simple and effective anesthetic method for providing regional anesthesia of the upper limbs during carpal tunnel release surgery [CTRS]. However, the procedure is associated with significant postoperative pain and adjuvant analgesic agents are recommended. The Aim of The Work: This study aimed to compare the analgesic effects of magnesium sulfate and tramadol when added to lidocaine for IVRA during CTRS. Methods: In this double-blinded, randomized clinical trial, 60 ASA I-II patients eligible for elective CTRS with IVRA were randomly allocated into one of 3 groups. The first group [lidocaine group] received IVRA with 40 ml lidocaine 0.5%. The second group [lidocaine + tramadol group] received IVRA with40 ml 0.5% lidocaine and tramadol 1mg/kg. The third group [lidocaine + magnesium sulphate group] received IVRA with 40 ml 0.5% lidocaine and magnesium sulfate 10 mg/kg and normal saline. Outcome parameters included time to onset of sensory and motor block, time to onset of tourniquet pain, need of intra-operative analgesia, intraoperative consumption of fentanyl, duration of postoperative analgesia and pain intensity were noted in each patient. Results: Comparison between the studied groups regarding the outcome parameters. The Lidocaine + Tramadol and the Lidocaine + Magnesium groups achieved better performance in all the studied parameters in comparison to the Lidocaine group. In addition, Lidocaine + Tramadol groups had significantly better performance in comparison to the Lidocaine + Magnesium group. No significant differences were reported between the studied groups regarding post-operative complications Conclusions: Use of tramadol and magnesium sulphate as adjuvants to lidocaine achieved better performance in all the studied parameters in comparison to the lidocaine only. In addition, tramadol had significantly better performance in comparison to magnesium sulphate without significant side effects