संज्ञानश्वासन और निदान शोध जर्नल
खुला एक्सेस
आईएसएसएन: 2155-6148
आईएसएसएन: 2155-6148
Mona Mohamed Mogahed and Atteia Gad Anwar
Background and objective: Upper limb surgeries under Intravenous regional anesthesia (IVRA) with the traditional dose of lidocaine may lead to side effects incompatible with life safety. Anesthetists attempted many modified techniques of IVRA to use a lesser dose of lidocaine combined with some adjuvants to avoid these side effects.
Aim and work: The primary outcome was to compare the first analgesic requirement time of when adding lornoxicam and dexmedetomidine to lidocaine IVRA in outpatients who underwent upper limb surgery, and the secondary outcomes were to compare the onset of sensory and motor blocks, the tourniquet pain and the sensory and motor block recovery times at postoperative period.
Patient and methods: Patients were randomly into two groups each group with 50 patients. Group I (G I) were given solely 3 mg/kg of 0.5% lidocaine diluted with normal saline in a volume of 40 ml. Group II (GII) were given 1.5 mg/kg of 0.25% lidocaine plus 8 mg of lornoxicam and 0.5 μg/kg dexmedetomidine all diluted with normal saline in a total volume of 40 ml. Numerical Rating Score (NRS) was used to assess the sensory block. Motor blockade assessment was done by Modified Bromage Scale Tourniquet pain was noted by using the Numeric rating scale (NRS) before tourniquet inflation (BT), 5 min after tourniquet inflation, tourniquet inflation, every 10 min after tourniquet inflation, at tourniquet release, after 30 min, 2 h, and 4 h of tourniquet release.
Results: Sensory and motor block onset times (min) were significantly delayed in group II than in group I (p=0.001). Sensory and motor recovery times after release of tourniquet (min) after release of tourniquet (min) were more prolonged in group II than in group I (p=0.001). Significant differences in the number of patients who had tourniquet pain as more patients in group I showed tourniquet pain (p=0.007), Time of onset of tourniquet pain (min ) and the first analgesia requiring time after release of tourniquet were significantly delayed in group II than in group I (p=0.001), While the total intraoperative fentanyl requirement (μg) was significantly lower in group II than in group I(p=0.001). More patients developed postoperative complications in group I than in group II, but this was not statistically significant (p>0.05).
Conclusion: Adding lornoxicam-dexmedetomidine to 0.25% lidocaine in comparison with 0.5% lidocaine for IVRA alone causes a short delay in the onset and the attainment of complete sensory and motor blocks; however this safe and effective combination can be used in IVRA for upper limb surgeries with better analgesic effect and lesser probability of local anesthetic toxicity.