الفهرس 
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Abstract
Intravenous regional anesthesia (IVRA) was first used by August Bier in 1908.This technique is easy,reliable and cost-effective when used in short operative procedures of hand or forearm.Tourniquet pain and lack of postoperative analgesia after tourniquet release are the major limitations to this technique.
To improve the efficacy of IVRA, various agents such as tramadol, clonidine, neostigmine are added to the local anesthetics.Also various nonsteriodal anti-inflammatory drugs (NSAIDs) have been demonstrated to enhance analgesia such as ketorolac, in IVRA.
Acetaminophen is an analgesic which relieves pain and reduces fever.Perfalgan ( Bristol-Myers Squibb, France ) is a solution of acetaminophen administrated intravenously in order to relieve pain or reduce fever following surgery.
We planned this study to evaluate the effect of intravenous acetaminophen and ketorolac on sensory block onset times,tourniquet pain and postoperative analgesia when added to lidocaine for IVRA.
Forty-five healthy patients ( ASA physical status I and II), in the age group of 22-55 years, scheduled for ambulatory hand surgery were selected for the study.They received IVRA and were assigned to three groups:
Group C (Control group): received 2% lidocaine (3 mg/kg; maximum:200mg) diluted with 0.9% normal saline to a total volume of 40 ml (n = 15).
Group P )paracetamol group): received 2% lidocaine (3 mg/kg; maximum:200mg) plus 200 mg of paracetamol ( perfalgan 10 mg/ml) diluted with 0.9% normal saline to a total volume of 40 ml (n = 15). and Group K (Ketorolac group): received 2% lidocaine (3 mg/kg; maximum:200mg) plus 20 mg ketorolac diluted with 0.9% normal saline to a total volume of 40 ml (n = 15).
Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed.
Data was statistically described in terms of mean and standard deviation, median frequencies and relative frequencies(%). For parametric data, unpaired students t-test was used to compare the three groups in each period of the study. For non-parametric data, chi-square test was used. A probability (p value) <0.05 was considered statistically significant.
Sensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C.
So,the primary outcome of this study was- addition of intravenous acetaminophen to lidocaine for IVRA shortens onset time of sensory block and delays tourniquet pain onset time , but not with ketorolac.Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.