Abstract
Background and Aims: Intravenous Regional Anesthesia (IVRA) provides analgesia of distal part of limb by intravenous injection of local anesthesia in to the vein of the same limb, while the circulation to the limb is occluded by application of tourniquet. However, IVRAis limited by local anesthesia toxicity, tourniquet pain and absence of postoperative analgesia. Various additives to local anesthetics such as ketamine, clonidine, opiods, NSAIDs are used to address these issues. The aim of our study was to evaluate the effectiveness of Dexmedetomidine to low dose Lidocaine solution for IVRA.Patients and Methods: A prospective, randomized double blind study was conducted on 60 patients divided in to two groups of thirty each; Group I patients received 40 ml of Lidocaine 0.25% while Group II patients received 40 ml of 0.25% of lidocaine mixed with I mcg/kg of dexmedetomidine. The motor and sensory block onset and recovery times were assessed. Tourniquet pain and sedation score were assessed intraoperatively and postoperatively.Results: Sensory and motor block onset times were shorter and recovery times were prolonged in Dexmedetomidine group. The quality of anesthesia was better in the Dexmedetomidine group and the fentanyl dose required was also lower in the dexmedetomidine group. There was a significant difference in the postoperative analgesia time which was demonstrated by less use of intramuscular diclofenac in dexmedetomidine group.Conclusions: A safe intravenous dose of lidocaine can be used for IVRA for superficial hand surgery, and the addition of I mcg /kg dexmedetomidine shortened the onset times for both sensory and motor blockade and improved the quality of anesthesia, with prolonged postoperative analgesia time. By adding dexmedetomidine we were able to reduce the dose of lidocaine to 0.25% concentration without compromising analgesia. JMS 2016; 19(1):21-25
Highlights
Intravenous regional anesthesia (IVRA) is a type of regional anesthesia that is executed by using pressure to the proximal extremity with the use of a pneumatic tourniquet isolating the limb from systemic circulation
The intraoperative visual analog scale (VAS) score for tourniquet pain after inflation at 5, 10, 15, 20, and 40 minutes was significantly higher in group I patients
Our study demonstrated that the addition of I mcg/kg dexmedetomidine to lidocaine for IVRA allowed the use of a low-lidocaine dose to the safe intravenous dosage limit, as a consequence decreasing the likely risk of local anesthetic toxicity in case of malfunction or early release of the tourniquet
Summary
Intravenous regional anesthesia (IVRA) or Bier's block was first introduced by August Bier, a German surgeon, in 1902.1 IVRA is technically simple and reliable, with success rates between 94% and 98%.1 IVRA is a type of regional anesthesia that is executed by using pressure to the proximal extremity with the use of a pneumatic tourniquet isolating the limb from systemic circulation. IVRA is a type of regional anesthesia that is executed by using pressure to the proximal extremity with the use of a pneumatic tourniquet isolating the limb from systemic circulation. This anesthesia technique is considered easy with fast anesthesia induction, fast recovery, fast muscle relaxation, and with better ability to control anesthesia region. Conclusions: A safe intravenous dose of lidocaine can be used for IVRA for superficial hand surgery, and the addition of I mcg /kg dexmedetomidine shortened the onset times for both sensory and motor blockade and improved the quality of anesthesia, with prolonged postoperative analgesia time. JMS 2016; 19(1):[21-25] Keywords: dexmedetomidine, intravenous regional anesthesia, lidocaine
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