Key result
Surgical field infiltration with adrenaline 1:200,000 alone caused significant tachycardia and hypertension (P<0.001), whereas adding lignocaine provided stable haemodynamics and better analgesia.
Why the study?
Do different concentrations of adrenaline with or without lignocaine affect haemodynamic responses and postoperative analgesia in children undergoing cleft lip/palate surgery?
RCT (n=100)
double-blinded
randomised into four groups
Do different concentrations of adrenaline with or without lignocaine affect haemodynamic responses and postoperative analgesia in children undergoing cleft lip/palate surgery?
p-value: p=<0.001
Adding lignocaine to adrenaline infiltration (1:400,000 or 1:200,000) provides stable haemodynamics and better postoperative analgesia in children undergoing cleft surgery.
Adding lignocaine to adrenaline infiltration stabilizes hemodynamics and improves analgesia in pediatric cleft surgery; extends RCT evidence for combined regimens in children.
Surgical field infiltration with adrenaline is common practice for quality surgical field during cleft lip and palate repair in children. Intravascular absorption of adrenaline infiltration often leads to adverse haemodynamic responses. In this prospective, double-blinded, randomised study the haemodynamic effects, quality of surgical field and postoperative analgesia following surgical field infiltration with different concentrations of adrenaline with and without lignocaine were compared in 100 American Society of Anesthesiologists physical status I children aged six months to seven years undergoing cleft lip/palate surgery. A standard anaesthesia protocol was used and they were randomised into four groups based on solution for infiltration: adrenaline 1:400,000 (group A), adrenaline 1:200,000 (group B), lignocaine + adrenaline 1:400,000 (group C) and lignocaine + adrenaline 1:200,000 (group D). Statistically significant tachycardia and hypertension occurred only in group B as compared to other groups (P <0.001). The peak changes in heart rate and mean arterial pressure following infiltration occurred at 4.3 ± 2.4, 3.8 ± 1.5, 5.7 ± 3.2 and 5.9 ± 4.9 minutes in groups A, B, C and D respectively. Surgical field was comparable among all groups. Postoperative pain scores and rescue analgesic requirements were lesser in the groups where lignocaine was added to the infiltrating solution (P <0.05). We found that 1:400000 or 1:200000 adrenaline with lignocaine 0.5 to 0.7% is most suitable for infiltration in terms of stable haemodynamics, quality of surgical field and good postoperative analgesia in children.
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Muthukumar et al. (2012) conducted an RCT in cleft lip and cleft palate (n=100). Adrenaline with lignocaine vs. Adrenaline without lignocaine was evaluated on Haemodynamic effects, quality of surgical field and postoperative analgesia (p=<0.001). Surgical field infiltration with adrenaline 1:200,000 alone caused significant tachycardia and hypertension (P<0.001), whereas adding lignocaine provided stable haemodynamics and better analgesia.
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