Objective: To compare Lignocaine Hydrochloride and Atracurium Besylate combination with Lignocaine Hydrochloride Alone for Onset and Recovery of Sensory and Motor Block in Intravenous Regional Anaesthesia (IVRA) (Bier’s Block).

Method: 75 patients of ASA I and II scheduled for routine and emergency upper extremity surgeries (lasting upto 1 hour) were randomly selected. Patients were divided into three groups (25 in each) – Group A (0.5% lignocaine hydrochloride (preservative free) 40ml)-Control Group. Group B (0.5% lignocaine hydrochloride 40ml + atracurium 2mg) Study Group. Group C (0.5% lignocaine hydrochloride 40ml + atracurium 4mg) Study Group. After preoperative preparation, a padded double cuff tourniquet was positioned around the upper arm, on the side to be operated. Exsanguination of the limb was done, and then proximal tourniquet was inflated to 50 mm Hg above the systolic pressure. According to the groups, the drug was injected. Onset of sensory and motor block, degree of motor block was assessed. After complete analgesia, distal cuff was inflated 50mm Hg above the systolic pressure and proximal cuff deflated. After the completion of surgery, the cuff was deflated. Haemodynamic parameters (Pulse rate, SBP, DBP, RR), any complications and recovery of sensory and motor block was assessed.

Results: The mean time for the onset of sensory block was 7.04 + 1.59 mins, 5.52+ 1.19 min and 4.64 + 1.29 min in group A,B,C respectively. The mean onset of motor block was 13.84 + 2.13 min, 6.92 + 1.26 min, 5.88 + 1.62 min in group A,B,C respectively. The onset of sensory and motor block was early in the study group as compared to control group and was statistically significant. Grading of motor block was excellent in study group. Group B and C had longer sensory and motor recovery time and was statistically significant. Haemodynamic parameters did not show any difference in three groups. No complications were noted.

Conclusion: 0.5% lignocaine hydrochloride 40ml produces good sensory and motor blockade during IVRA. Addition of atracurium along with lignocaine hydrochloride shortens the onset of sensory and motor block and also improves the degree of motor block and increases the recovery time of sensory and motor block. Addition of atracurium to lignocaine is advantageous during IVRA in regard to onset of block and muscle relaxation.