ADDITION OF DEXMEDETOMIDINETO LIGNOCAINE FOR INTRAVENOUS REGIONAL ANESTHESIA IN UPPER EXTREMITY ORTHOPAEDIC SURGERIES
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i4.44472Keywords:
Intravenous regional anesthesia, Dexmedetomidine, Lignocaine, Sensory, MotorAbstract
Objective: The objective of this study was to determine the duration of onset and regression time of sensory and motor blocks, the quality of anesthesia, and post-operative analgesia by the addition of dexmedetomidine to local anesthetic solution in intravenous regional anesthesia (IVRA) in upper extremity orthopedic surgeries.
Methods: This is a prospective, randomized, and double blind clinical trial. Ninety American Society of Anaesthesiologists Grade I and II patients of either gender between 18 and 60 years of age scheduled for elective upper extremity orthopedic surgeries lasting for <90 min were included in the study. Patients were randomly allocated to two Groups A and B of 45 each. Group A received 3 mg/kg preservative free lignocaine alone and Group B received 3 mg/kg preservative free lignocaine with dexmedetomidine, 0.5 μg/kg in IVRA.
Result: Onset time of sensory blockade in Group A and B was 5.6±0.93 min and 3.9±0.63 min, respectively. Onset time of motor blockade in Group A and Group B was 15.01±4.53 min and 10.74±3.64 min, respectively. The difference in onset time of sensory and motor blockade between the two groups was statistically significant (p<0.05). Sensory blockade recovery time after release of tourniquet was 6.9±0.53 min in Group A and 29.21±5.23 min in Group B. Motor blockade recovery time was 4.35±0.76 min for Group A and 12.32±7.23 min for Group B. The difference in sensory and motor blockade recovery time between the two groups was statistically significant (p<0.05).
Conclusion: Dexmedetomidine on addition to lignocaine for IVRA provided rapid onset of sensory and motor blockade, prolonged duration of sensory and motor blockade, and reduced tourniquet pain.
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References
Sardesai SP, Patil KN, Sarkar A. Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia. Indian J Anaesth 2015;59:733-8. doi: 10.4103/0019-5049.170034, PMID 26755839
Khanna P, Arora MK, Sunder RA. Adjuvants for intravenous regional anaesthesia. J Anaesthesiol Clin Pharmacol 2010;26:287-91.
Beecham GB, Bansal P, Nessel TA, et al. Lidocaine. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. [Last updated on 2021 Dec 19].
Pitkänen MT, Suzuki N, Rosenberg PH. Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chlorprocaine. A double-blind comparison in volunteers. Anaesthesia 1992;47:618-9. doi: 10.1111/j.1365-2044.1992.tb02340.x, PMID 1626679
Singh P, Bajaj JK, Gogia AR. Comparison of ropivacaine and lignocaine intravenous regional anaesthesia in upper limb surgeries. Astrocyte 2015;2:16-20. doi: 10.4103/2349-0977.168252
Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomized double-blind prospective study. Indian J Anaesth 2012;56:243-9. doi: 10.4103/0019-5049.98767, PMID 22923822
Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: A systematic review and meta-analysis. Br J Anaesth 2013;110:915-25. doi: 10.1093/ bja/aet066, PMID 23587874
Halaszynski TM. Dexmedetomidine: A look at a promising new avenue of use. Saudi J Anaesth 2012;6:104-6. doi: 10.4103/1658-354X.97019, PMID 22754432
Afonso J, Reis F. Dexmedetomidine: Current role in anesthesia and intensive care. Rev Bras Anestesiol 2012;62:118-33. doi: 10.1016/ S0034-7094(12)70110-1, PMID 22248773
Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004;98:835-40. doi: 10.1213/01. ane.0000100680.77978.66, PMID 14980948
Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: A novel sedative-analgesic agent. Proc (Bayl Univ Med Cent) 2001;14:13- 21. doi: 10.1080/08998280.2001.11927725, PMID 16369581
Brown AR. Benefits of regional anesthesia over general anesthesia for outpatient rotator cuff surgery. Anesthesiology 2006;104:207.
Chan VW, Peng PW, Kaszas Z, Middleton WJ, Muni R, Anastakis DG,et al. A comparative study of general anaesthesia, intravenous regional anaesthesia, and axillary block for outpatient hand surgery: Clinical outcome and cost analysis. Anesth Analg 2001;93:1181-4. doi: 10.1097/00000539-200111000-00025, PMID 11682392
Gupta A, Mahobia M, NN, Mahendra R. A comparative study of two different doses of dexmedetomidine as adjunct to lignocaine in intravenous regional anaesthesia of upper limb surgeries. Int J Sci Stud 2014;2:53-62.
Esmaoglu A, Mizrak A, Akin A, Turk Y, Boyaci A. Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia. Eur J Anaesthesiol 2005;22:447-51. doi: 10.1017/s0265021505000761, PMID 15991508
Subramanya V, Kapinigowda ST, Math AT, Chennaiah VB. Dexmedetomidine as an adjuvant for intravenous regional anesthesia in upper limb surgeries. Anesth Essays Res 2017;11:661-4. doi: 10.4103/0259-1162.206851, PMID 28928567
Gentili M, Bernard JM, Bonnet F. Adding clonidine to lidocaine for intravenous regional anesthesia prevents tourniquet pain. Anesth Analg 1999;88:1327-30. doi: 10.1097/00000539-199906000-00024, PMID 10357339
Kamath K, Kamath SU, Tejaswi P. Incidence and factors influencing tourniquet pain. Chin J Traumatol 2021;24:291-4. doi: 10.1016/j. cjtee.2021.05.002, PMID 34281783
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