JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

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2020 Month : February Volume : 7 Issue : 5 Page : 218-223

Effect of Lidocaine Pre-Treatment on Myoclonus during Induction of Anaesthesia with Etomidate- A Randomised, Double-Blind, Placebo-Controlled Study

Rita Rajkumari1, Longjam Eshori2, L. Deban Singh3, Maharabam Binarani4, Samya Musthafa5, Adrish Banik6, Ruth Lalnuntawmpuii7

Corresponding Author:
Dr. Longjam Eshori,
Associate Professor,
Department of Anaesthesia,
Regional Institute of Medical Sciences,
Lamphelpat, Imphal- 795004, Manipur.
E-mail: eshoridr@gmail.com
DOI: 10.18410/jebmh/2020/46

ABSTRACT
BACKGROUND
Etomidate is widely used for induction of general anaesthesia and sedation, especially in elderly patients and hemodynamically unstable patients. However, myoclonus is one of the most prominent problems encountered during induction of anaesthesia with etomidate. Many agents have been used to prevent it including lidocaine. This prospective, randomised controlled study was taken up to evaluate the effect of pre-treatment with lidocaine versus placebo on the incidence and severity of myoclonus at one minute and two minutes after induction of anaesthesia with etomidate for elective surgeries.

METHODS
One hundred adult patients were randomly assigned into two groups to receive saline placebo (Group I) and IV lignocaine 1 mg/Kg (Group II). Group I (n=50) received 6 ml of normal saline (placebo) and Group II received lidocaine, 1 mg/Kg, diluted with normal saline up to 6 ml. Double blinding was achieved by making the principal investigator and the patient unaware of which drug was given. Two minutes after administering the study drug, intravenous etomidate (Troymidate, Troikaa) 0.3 mg/Kg was administered over 30 seconds and the patient was monitored for myoclonus over the next two minutes.

RESULTS
At one-minute, myoclonus was seen in 34 patients (68%) and 15 patients (30%) respectively in Group-I and Group-II. There was a statistically significant reduction in the incidence of myoclonus at one minute in Group-II compared to Group-I (p<0.05). At two-minutes myoclonus was seen in 32 patients (64%) and 19 patients (38%) respectively in Group-I and Group-II. There was a statistically significant reduction in the incidence of myoclonus at two minutes in Group-II compared to Group-I (p<0.05).

CONCLUSIONS
Lignocaine 1 mg/Kg pre-treatment significantly reduces the incidence of Etomidate induced myoclonus (EM) compared with the control group.

KEYWORDS
Anaesthesia, Etomidate, Lidocaine, Myoclonus, Premedication