الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Nitroglycerine was used in the management of angina as early as 1879. Since then, it has become one of the most widely used anti-ischemic agents. Nitroglycerine has numerous vascular effects that decrease myocardial ischemia, although it is thought that those mechanisms that alter the balance between myocardial oxygen demand and supply are the most important. Nitroglycerine is metabolized to nitric oxide which causes an increase in the intracellular concentration of cyclic guanosine monophosphate and produces pain modulation in the central and peripheral nervous system. Nitric oxide generators also induce anti-inflammatory effects and analgesia by blocking hyperalgesia and the neurogenic component of inflammatory edema. Another possible mechanism includes an analgesic effect through the direct stimulation of peripheral fibers mimicking the actions of locally applied acetylcholine. The clinical efficacy of transdermal NTG for acute pain relief such as treatment of shoulder pain and thrombophlebitis and for enhancing the effect of spinal sufentanil or neostigmine. Also addition of NTG to lidocaine in intravenous regional anesthesia improves the quality of anesthesia and postoperative analgesia. By inducing moderate hypotension, the use of transdermal nitroglycerine decreases intraoperative blood loss and the need for transfusion. The aim of this study was: -To evaluate the effects of adding nitroglycerine to lidocaine for IVRA on tourniquet pain, sensory and motor block onset and recovery times and postoperative pain and analgesics consumption.
- and to evaluate the effects transdermal patches (5 or 10 mg) during hip hemiarthroplasty surgery by spinal anesthesia using bupivacaine and fentanyl to assess its role in reducing intraoperative blood loss and in enhancing postoperative analgesia of intrathecal fentanyl and analgesics consumption.
This study was carried on 100 patients divided into two main groups, Group I consists forty patients were scheduled for hand or forearm surgery divided into two equal subgroups and received IVRA using 3mg/kg of lidocaine 2% diluted with normal saline solution to total volume 40 ml in subgroup 1 and with 100µ nitroglycerine in subgroup 2 to evaluate the effect of nitroglycerine added to lidocaine on intraoperative sensory and motor block onset and recovery times, onset of tourniquet pain, postoperative analgesia and analgesics consumption. Group II consists sixty patients were scheduled for hip hemiarthroplasty surgery divided into three equal subgroups and given spinal anesthesia (using 15 mg of heavy bupivacaine 0.5 % and 25µ fentanyl with total volume 3.5 ml) in subgroup 3, subgroup 4 and subgroup, twenty minutes after spinal anesthesia, transdermal patches 5mg in subgroup 4 or 10 mg subgroup 5 was applied to assess its role in reducing intraoperative blood loss and postoperative analgesia and analgesics consumption.
The main results of this study revealed that adding nitroglycerine as an adjuvant to lidocaine for intravenous regional anesthesia improves sensory and motor block onset and recovery, decreases tourniquet pain, prolongs postoperative analgesia and decreases analgesic consumption, without significant side effect. While using transdermal patch with spinal anesthesia prolongs postoperative analgesia of intrathecal fentanyl and decreases analgesic consumption but had no effect on blood loss without any significant complications.
On comparing the effect of tansdermal patch 10mg with that of tansdermal patch 5mg on postoperative VAS scores, the first postoperative analgesic requirement time and diclofenac consumption, there was no significant difference but tansdermal patch 10mg produces a significant difference in lowering MAP.