Effect of various analgesics combined with ropivacaine on pain, sensory-motor block and hemodynamic changes in intravenous regional anesthesia

Abstract

Background: The study addressed the compared effects of adding dexmedetomidine (DEX), ketamine (KET), neostigmine (NEO), and magnesium sulfate (MS) to ropivacaine on pain relief and hemodynamic changes in intravenous regional anesthesia (IVRA) during distal radius surgery. Materials and Methods: This randomized, double blinded clinical trial recruited the following five groups of patients (n = 150) undergoing forearm surgery under IVRA, hospitalized at Valiasr Hospital (Arak, Iran): DEX, KET, NEO, MS, and placebo, in which ropivacaine 0.2% was used along with all the drugs. Subsequently, we measured the onset and duration of sensory motor block, pain score, arterial oxygen saturation (SaO2), mean arterial pressure (MAP), and heart rate (HR), as well as the quantity of opioid administration throughout the 24 h postoperatively. Results: In each group, thirty patients were randomized and included in the analysis. The time to the onset of sensory motor block was shorter in the DEX group (P = 0.001) who had a longer duration of sensory motor block (P = 0.001), lower pain score at all times (P = 0.001), and the lowest opioid use (P = 0.001). There was no statistically significant difference between the five groups in terms of MAP (P = 0.148), HR (P = 0.642), and SaO2(P = 0.990), but the time trend of MAP (P = 0.001) and SaO2(P = 0.001) was statistically significant and also the interaction of time and groups was statistically significant for MAP (P = 0.001) and HR (P = 0.001). Conclusion: DEX demonstrated the least amount of postoperative pain and opioid use, as well as a rapid onset and a longer duration of sensory motor block than other drugs used. Moreover, it could be thought to be an excellent recommendation to use as an adjuvant in IVRA. Trial registration: Clinical trial registration number in Iranian randomized clinical trial: IRCT20141209020258N113.