Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 11826

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Readers' Comments (0) Article in PDF Audio Visual Citation Manager Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1610 - 1613

Comparison of Alkalinized and Non-Alkalinized Lignocaine in the Brachial Plexus Block

Ramesh Koppal, Adarsh E.S., Prakashappa D.S., Anilkumar G.

1. Associate Professor ,Dept of Anaesthesiology S. Nijalingappa Medical College, Bagalkot, Karnataka, India. 2. Assistant Professor, Dept of Anaesthesiology. S. Nijalingappa Medical College, Bagalkot, Karnataka, India. 3. Professor and Head ,Dept of Anaesthesiology S. Nijalingappa Medical College, Bagalkot, Karnataka, India. 4. Assistant Professor, Dept of Anaesthesiology. S. Nijalingappa Medical College, Bagalkot, Karnataka, India.

Correspondence Address :
Ramesh Koppal,
Associate Professor, Dept of Anaesthesiology,
S N Medical College.Navnagar, Bagalkot- 587102.
Karnataka, India.
E-mail: rameshkoppaldr@rediffmail.com

Abstract

Introduction: Interruption of pain is central to the anaesthetic practice. Regional anaesthesia is one of the widely practiced ways for mitigating surgical pain. Many long acting local anaesthetics have been tried, viz.. bupivacaine, ropivacaine … but they are limited by the drawbacks of delayed onset, the varying quality of the blockades and their unpredictable duration of action. The alkalinization of lignocaine has been shown to fasten the onset, potency and the duration of the block.

Type of study: Randomized single blind clinical trial.

Materials and Methods: After obtaining the institutional ethical committee clearance and their written informed consent, fifty patients who were aged between 25-50 yrs, of either sex, who belonged to ASA grade 1 and 2, who were posted for elective/ emergency surgery of the upper limb were enrolled for the study. Group 1 received 30ml of 1.5% lignocaine with adrenaline and Group 2 received 30 ml of 1.5% alkalinized lignocaine with adrenaline. A supra-clavicular block by a classical approach was made and the degree of the blockade was graded. The results were tabulated and analyzed by using appropriate statistical tests.

Conclusion: Alkalinization of lignocaine offers an earlier onset and it provides a good intensity and adequate depth and a satisfactory distribution of the regional block.

Keywords

Anesthesia, Local block

How to cite this article :

Ramesh Koppal, Adarsh E.S., Prakashappa D.S., Anilkumar G.. COMPARISON OF ALKALINIZED AND NON-ALKALINIZED LIGNOCAINE IN THE BRACHIAL PLEXUS BLOCK. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Apr 21 ]; 5:1610-1613. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1610-1613&id=1812

Introduction
The central axis of anaesthesia is predicated by the interruption of pain. Over a period of several years, many local anaesthetic agents have evolved viz, bupivacaine, ropivacaine, etc .The main drawbacks of these long acting drugs are their delayed onset of action, the varying quality of the blockade and their unpredictable duration of action. To overcome these drawbacks, the following have been tried viz. the addition of enzymes, oils, alkalinization, potassium, glycol and vaso-constricting agents, warming up of the local anaesthetic solutions, potentiation of the blockade by pain and muscular exercises.

Out of all the above, alkalinization has been shown to hasten the onset, the potency and the duration of the block (1) (2). Hence, in our study, an attempt was made to evaluate the effect of alkalinized lignocaine with respect to the onset and the degree and duration of the blockade in the supraclavicular brachial plexus block.

Material and Methods

After obtaining the institutional ethical committee clearance and their written informed consent, fifty patients in each group who were aged between 25-50 yrs, of either sex, who belonged to ASA grade 1 and 2, who were posted for elective surgery of the upper limb, were enrolled for the study. The exclusion criteria were renal, liver and neurological disorders and a history of an allergic reaction to local anaesthetics.

All the patients were investigated by assessing their haemoglobin levels, random blood sugar, serum electrolytes, serum creatinine, urine albumin, chest X-ray and ECG. The study population was randomly assigned into two groups by using a randomization table.

Group 1 received 30 ml of 1.5% lignocaine with adrenaline and Group 2 received 30 ml of alkalinized 1.5% lignocaine with adrenaline for the block.

30 ml of 1.5% lignocaine with adrenaline (for group 1) was prepared with 22.5 ml of 2% lignocaine, 1.5 ml of adrenaline (1 ml=100 microgram diluted), and 6 ml of normal saline. This solution was tested for pH, which revealed a pH of 6.38.

30 ml of alkalinized 1.5% lignocaine (for group 2) was prepared by adding 3.5 ml of 7.5% sodium bicarbonate 1.12 ml=1 mEq), 1.5 ml of adrenaline (1 ml=100 microgram diluted), 2.5 ml of normal saline and 22.5 ml of 2% lignocaine. Finally, the prepared solution was tested for pH, which revealed a pH of 7.25.

A supra-clavicular block by using a classical approach was made and the degree of the blockade was graded 2 as follows;

Proximally • Grade-0 Difficulty in elevating the arm off the table (paresis) • Grade-1 Inability to move the arm at all (paralysis).

Distally • Grade-0 No motor block • Grade-1 Paresis • Grade-2 Paralysis (of hand was determined by checking for inability in flexing the wrist against gravity and movements)

The person who performed the procedure was blinded with regards to the drug which was used. The study drug which was to be used was selected based on a computer generated randomization. The onset and the spread of the sensory and motor blockade were assessed every minute after injecting the local anaesthetic solution.

The sensory block was assessed by checking for a pin prick sensation in the axillary, median and the ulnar distribution areas.

The heart rate, ECG and SpO2 were monitored continuously and the noninvasive blood pressure was recorded every 5 minutes. The patients were watched for bradycardia (Heart rate <60), convulsions, drowsiness and any other complications.

The onset of the sensory and the motor blockade was determined proximally and distally to allow the differentiation of their onset in the mantle and core fibers. Proximally, the onset of analgesia and anaesthesia was determined over the lower deltoid muscle in the distribution of the axillary nerve and distally, over the thumb and the little fingers in the distribution of the median and ulnar nerves respectively.

The onset of the motor blockade was determined proximally in the deltopectoral group of muscles and distally in the muscles of the hand to allow the differentiation of the onset in the mantle and core fibers.

Definitions
Analgesia: The time of injection to the time of onset of the loss of pain on pinprick

Anaesthesia: The time of injection to the time of onset of the loss of touch and pressure by pin prick.

Paresis: Grade 1, The time of injection to the time of onset of the loss of the motor power (partial motor block)

Paralysis: Grade 2, The time of injection to the time of complete motor loss ( complete motor block)

Penetration time: The time of injection to the time of the proximal paresis.

Intra-neural-diffusion: The time of the proximal paresis to the time of the complete distal sensory block.

Duration of sensory blockade: The time in minutes from the onset of analgesia to the recurrence of the pain to pinprick at the proximal and the distal levels was noted.

Duration of motor blockade: The time in minutes from the onset of the paresis to the recurrence of the motor movements at both the proximal and the distal groups.

Results

Results and observation
Both the groups (50 in each group) were compared for any difference in height, weight, age, sex, distribution, time of onset, duration and the degree of the blockade. The statistical analysis consisted of the 1) Two tailed student t test and the 2) Z test. A p value of less than 0.05 (P < 0.05) was considered as statistically significant, In the Z test, a value of more than 1.96 (Z>1.96) was considered to be significant.

(Table/Fig 1) shows the sex distribution of the study subjects. (Table/Fig 2) shows their age, height and weight (mean ± S.D). (Table/Fig 3) shows the onset of the sensory blockade (mean ± S.D in minutes). (Table/Fig 4) shows the onset of the motor blockade (mean ± S.D in minutes). (Table/Fig 5) shows the duration of the sensory and the motor blockade (mean ± S.D in minutes). (Table/Fig 6) shows the rate of penetration and diffusion (mean in minutes).

Discussion

Brachial plexus blocks are widely used for upper limb surgeries. A supraclavicular approach for a brachial block results in a homogenous blockade. Lignocaine is an amide local anaestheticwhich is widely used because of its shorter latency, but it has the disadvantage of a shorter duration of action.

Morrisson D H suggested that a volume of 0.05 ml/2.45 cm2 of height (3), to give this volume with 2% lignocaine with adrenaline toxic limits would exceed. With a 1% lignocaine solution, the dose would be highly inadequate to provide good analgesia and motor blockade. Hence, in our study, we used an optimal concentration of 1.5% lignocaine with adrenaline to give an adequate volume dosage within the therapeutic range.

The present study assessed the effect of the addition of 3.5 ml of 7.5% sodium bicarbonate to 22.5 ml of 1.5% lignocaine. Normal saline was added to make the volume final to 30 ml, which produced the lignocaine strength of 1.5%. Fresh adrenaline was added to the solution to make the lignocaine 1.5% with adrenaline 1:200000 (5 microgram/ml) solution. The present study was aimed at bringingthe pH of lignocaine towards the pka value without changing the preparation.

The alkalinization of lignocaine hydrochloride led to a higher pH of > 6 and thus it was less dependent on the buffering capacity of the tissues. On injecting the alkalinized solution, the free base was liberated, the carbon dioxide rapidly diffused into the axon interior and the pH fell, which helped in the dissociation of the local anaesthetic to the active cationic form. This effect resulted in ion trapping, hence favouring the rapid movement of the local anaesthetic into the axon.

A tenfold increase in the degree of the block was observed with alkalinized lignocaine as compared to the hydrochloride salt by Catchlov et al (4) in vivo solutions.

In our study, the mean onset time of analgesia in the shoulder was 3.12 minutes, in the hand ulnar nerve area, it was 4.08 minutes and in the median nerve area, it was 4.52 minutes. In the control group, the mean onset time of analgesia in the shoulder was 6.24 minutes, in the hand ulnar region, it was 9.04 minutes and in the median region, it was 7.48 minutes.

The complete sensory blockade with the study group in the shoulder occurred within 4.4 minutes, in the hand (median), it occurred within 6.3 minutes and in the hand (ulnar), it occurred within 9 minutes . In the control group, a complete sensory blockade in the shoulder occurred after 8.24 minutes, in the hand (median), it occurred after 11.52 minutes and in the hand (ulnar), it occurred after 14.68 minutes.

The onset time for the motor block in the study group was only 2.28 minutes (proximal) and 4 minutes (distal). Complete paralysis occurred within 3.72 minutes (proximal) and 10.34 minutes (distal). In the control group, the onset time (paresis) was 4.88 minutes (proximal) and 6.92 minutes (distal). A complete motor blockade in the proximal area took more than 7.16 minutes and in the distal area, it took 17.08 minutes.

The average duration of the sensory blockade in the study group was 132 minutes as compared to 131 minutes in the control group and that of the motor blockade in the study group was 139.2 minutes and it was 138 minutes in the control group. So, in this study, the duration was nearly the same and it was statistically insignificant.

With alkalinization, the efficacy of the blockade improved significantly in the patients as compared to that in the control group. In the study group, 21 out of 25 patients achieved complete motor blockade (distal paralysis) and the depth of the sensory blockade was adequate, which reduced the need of adjuvants intraoperatively. In the control group, only 8 patients out of 25 achieved complete distal paralyses.

In 1986, Radha Sukani and Alon P Winnie (5) carried out a study which compared alkalinized and non-alkalinized lignocaine in the brachial plexus blockade by using a supra-clavicular technique. They found that alkalinized lignocaine reduced the latency by 45% as compared to non alkalinized lignocaine and that it produced a complete motor block in almost twice as many patients as non alkalized lignocaine (54% vs 31%). The duration of anaesthesia which was provided by the two agents was virtually identical, as was the motor blockade.

In 1995, Giorgio and Capogna et al (1) found that using alkalinized lignocaine in the axillary brachial plexus block produced a fasteronset and an earlier peak effect time and the onset of the motor block. Similar results were observed in a study which was conducted by A V Gormley W F et al in 1996.

The present study confirmed the results of Radha Sukani and Alon Winnie, W P Gormly et al and Giorgio Capogna et al regarding the onset, the degree of the blockade and its duration.

However, a study which was conducted by D G Ririe et al (6) on the effect of alkalinization of lignocaine on the median nerve block, observed an increased rate of motor block without any change in the onset or extent of the sensory block. In another study which was conducted by Ruby et al (7) to study the effect of the alkalinization of lignocaine hydrochloride on brachial plexus blocks, it was observed that alkalinization reduced the latency of the sensory and motor blockade and that it also increased the duration of the blockade.

Mark et al (8) observed that alkalinization did not have any significant effect and that it provided no clinical advantage.

In a recent study which was done by Jaichandran V et al, it was found that alkalinization also decreased the pain on injection of the local anaesthetic for the peribulbar block (9).

No drug related or technique related complications were observed during the study.

Conclusion

The alkalinization of lignocaine offers an earlier onset and it provides good intensity and adequate depth and a satisfactory distribution of regional block. There was not much difference in the duration of the blockade. The need of a intraoperative adjuvant was significantly reduced with the use of alkalinization.

References

1.
Capogna G, Celleno D, Costantino P, Muratori F, Sebastini M, Baldassini M. Alkalinization improves the quality of lidocaine fentanyl epidural anaesthesia for caesarean section. Can J Anaesth 1993; 40:425-30.
2.
AV Gormley WF, Hill DA, Murray JM, Fee JP. The effect of the alkalinization of lignocaine on axillary plexus anaesthesia. Anaesthesia 1996;51(2):185-88.
3.
Morrison DH Editorial. Alkalinization of local anaesthetics. CSA 1995; 42 (12):1076-79
4.
Catchlov, Richard FH. The influence of CO2 and pH on the local anaesthetic action. J Pharmacol.Exp.Ther 1972; 181 : 298-309.
5.
Sukani R, Winnie AP. The clinical pharmacokinetics of alkalinized local anaesthetics. A subclavian perivascular model. Anaesth Analg 1987; 66:739-45.
6.
Ririe DG, Walker FO, James RL, Butterworth J. Effect of the alkalinization of lidocaine on the median nerve block. Br J Anaesth 2000; 84: 163-68.
7.
Mehta R, Verma DD, Gupta V, Guruwara AK. To study the effect of alkalinizatiion of lignocaine hydrochloride on the brachial plexus block Indian J Anaesth 2003;47 :283-86.
8.
Chow MYH, Sia ATH, Koay CK, Chan YW. Alkalinization of lignocaine does not hasten the onset of the axillary plexus block. Anaesth Analg 1998; 86:566-8.
9.
Jaichandran V, Vijaya L, George RJ, Indermohan B. Peribulbar anesthesia for cataract surgery : Effect of Lidocaine warming and alkalinization on injection pain and motor and sensory blockade. Indian J Ophthalmol. 2010 Mar-Apr; 58(2):105-8.

DOI and Others

JCDR/2011/1812

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com