• Christopher M Viscomi, Alexander Friend, Colleen Parker, Todd Murphy, and Mark Yarnell.
• Department of Anesthesiology, University of Vermont College of Medicine, Burlington, VT 05401, USA. christopher.viscomi@vtmednet.org
• Reg Anesth Pain Med. 2009 Mar 1;34(2):130-3.

Background And ObjectivesKetamine delays and minimizes intraoperative tourniquet pain when added to lidocaine-based intravenous regional anesthesia (IVRA). It is unclear if adding ketamine to the IVRA injectate is more efficacious compared with systemic administration. This study compares intraoperative tourniquet pain, postoperative analgesia, and side effects of systemic versus IVRA ketamine during outpatient hand surgery.MethodsWe conducted a randomized, double-blind, systemic control study of 40 patients undergoing hand surgery using lidocaine IVRA. In group IVRA, 0.1 mg/kg ketamine in 1 mL of normal saline was added to the IVRA lidocaine, and 1 mL of normal saline was administered via a peripheral IV line. In group systemic, 1 mL of normal saline was added to the IVRA syringe, and 0.1 mg/kg ketamine in 1 mL of normal saline was administered via a peripheral intravenous line. Ten minutes after proximal tourniquet inflation, the distal tourniquet was inflated, and the proximal tourniquet deflated. Tourniquet pain was measured every 10 mins. Need for intraoperative opioids was recorded. Recovery room pain scores, analgesic needs, and sedation scores were compared. Patients were contacted 24 hrs after surgery and reported their analgesic consumption, satisfaction scores, and the occurrence of any unpleasant psychologic effects.ResultsGroups IVRA and systemic were comparable in demographic and surgical parameters. There were no differences between groups in intraoperative tourniquet pain scores, intraoperative fentanyl requirements, recovery room pain or sedation scores, postsurgical analgesic needs, or patient satisfaction scores.ConclusionsIn comparison to systemic administration, there is no selective benefit to adding ketamine to the IVRA injectate.

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