Fentanyl versus dexmedetomidine as adjuvants to lignocaine in intravenous regional anesthesia

Abstract

Background and objectives Intravenous regional anesthesia (IVRA) is a safe, simple, and inexpensive technique compared with general anesthesia for upper and lower limb surgeries. It also provides a bloodless area during surgery. Various adjuvants have tried to fasten the onset, prolong the duration of the block, and to increase postoperative analgesia. We compared fentanyl and dexmedetomidine as adjuvants to lignocaine for IVRA for upper limb surgeries. Patients and methods After the approval of the ethics committee of the institution, 64 patients of both sexes who were scheduled for optional hand or forearm surgery were divided into two groups (32 patients in each group); 32 patients received a 20 ml lignocaine 1%+1 µg/kg fentanyl in 5 ml supplemented with normal saline 0.9% (LF group) and 32 patients received 20 ml of lignocaine 1%+1 µg/kg dexmedetomidine in 5 ml supplemented with normal saline 0.9% (LD group). The following parameters were observed: blood dynamics, the time of the start of sensory and motor blockade, the need for analgesia during the operation, the time for first postoperative analgesia, and side effects between groups. Results There was a significant reduction in sensory and motor block onset in the fentanyl group compared with the dexmedetomidine group (P 0.05) in relation to the need for analgesia during the procedure. The results showed that patients in the LF group were more satisfied than the LD group (P 0.05). Conclusion We conclude that adding 1 μg/kg dexmedetomidine or 1 μg/kg fentanyl to lignocaine for IVRA improves the quality of anesthesia and perioperative analgesia without causing complications. We found that fentanyl reduces the time for onset of block and provided better patient satisfaction than dexmedetomidine although it scored the highest sedation score.