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ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 344-349

A comparative study on the effect of dexamethasone, dexmedetomidine, and lornoxicam as adjuncts to local anesthetic in intravenous regional anesthesia in forearm and hand surgery


Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
MD Tamer Y Hamawy
Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, 11361
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_71_18

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Background Intravenous regional anesthesia (IVRA) is a simple and reliable technique. The ideal IVRA solution should be rapid in onset and offers prolonged analgesia. The aim of this study was to assess the effects of different additives to local anesthetic in IVRA to provide a successful operative anesthesia with minimal analgesic requirements. Patients and Methods 80 patients ASA I–III scheduled for orthopedic and plastic surgeries in the forearm or the hand were randomly categorized into four groups, with 20 patients in each group. All groups received 30 ml of Lidocaine 1 % as IVRA solution in addition to the studied anesthetic adjunct. Group I (LD) received 8 mg dexamethasone in 2 ml Group II (LP) received 0.5 mcg/kg dexmedetomidine in 2 ml Group III (LL) received 8 mg lornoxicam in 2 ml Group IV (LS) received 2 ml normal saline 0.9% Mean arterial pressure and heart rate changes in the four study group changes were noted. Motor and sensory block onset and recovery times (minutes) and postoperative analgesic (gram paracetamol) consumption in the four study groups were recorded. Incidence of tourniquet pain and operative conditions were also assessed. Results The LP group showed a shorter time to onset of sensory block than the other three groups that was statistically significant with p<0.001. Both the LP and LL groups showed statistically significant longer time to recovery of sensory block (min) than the other groups (p<0.001). Both times to onset of motor block (min) and time to recovery of motor block (min) shows statistical insignificance regarding the relation between the 4 groups (p=0.073 and 0.794 respectively). Time to 1st postoperative analgesic request (min) was significantly late and the postoperative paracetamol consumption (gm) was significantly lower in the LP and LL groups than the other groups (p<0.001). Conclusion On studying different additives to lidocaine in IVRA, we found that dexmedetomedine and lornoxicam provide the best patient outcome regarding the onset and recovery of sensory block and prolonged analgesia.


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