Premedication With Dexmedetomidine Alone or Together With 0.5% Lidocaine for IVRA

Mızrak, Ayşe; Gül, Rauf; Erkutlu, İbrahim; Alptekin, Mehmet; Öner, Ünsal

doi:10.1016/j.jss.2009.03.005

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…[ 13 ] Peri-operative dexmedetomidine administration decreases the requirements for opioid or non-opioid analgesics both intra- and post-operatively. [ 14 ] Intravenous dexmedetomidine as a premedication was effective because it reduced patient anxiety, sympathoadrenal responses and opioid analgesic requirements, but it did not reduce tourniquet pain. [ 15 16 ] Even in our study, the patient satisfaction score was significantly better with dexmedetomidine than with clonidine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia

2015

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Background and Aims:Intravenous regional anaesthesia (IVRA) provides reliable and rapid analgesia with good muscular relaxation of the extremity distal to the tourniquet, but tourniquet pain and absence of post-operative analgesia are major drawbacks. α2 agonists, clonidine and dexmedetomidine are known to potentiate peripheral nerve blocks. The aim of this study was to compare clonidine and dexmedetomidine as adjuvants to IVRA with respect to block characteristics, tourniquet pain and post-operative analgesia.Methods:A prospective, randomised, double-blind study was conducted on 60 adult patients of American Society of Anesthesiologists physical status grades I and II, in two groups of 30 each, to receive either clonidine 1 μg/kg or dexmedetomidine 1 μg/kg added to 40 ml 0.5% preservative-free lignocaine. Independent samples t-test was used for analysing demographic data, haemodynamic data and block characteristics and Mann-Whitney U-test for skewed data.Results:Sensorimotor block onset was significantly faster and recovery delayed with dexmedetomidine as compared to clonidine. Intra-operative visual analogue scale (VAS) at 10 min, 15 min and 40 min and post-operative VAS at 30 min and 2 h were significantly higher with clonidine. Fentanyl consumption and sedation were comparable. Duration of analgesia was significantly longer with dexmedetomidine. Haemodynamic parameters were comparable.Conclusions:Dexmedetomidine significantly facilitates onset, prolongs recovery of sensory as well as motor block and also prolongs duration of analgesia as compared to clonidine. Both decrease tourniquet pain satisfactorily and have comparable intra-operative fentanyl requirement . Patient satisfaction is better with dexmedetomidine.

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Section: Discussionmentioning

confidence: 99%

Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia

2015

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“…[14] Perioperative dexmedetomidine administration decreases the requirements for opioid or non-opioid analgesics both intra and postoperatively. [15] IV dexmedetomidine as a premedication has been effective before IVRA because it reduces patient anxiety, sympathoadrenal responses, and opioid analgesic requirements but it did not reduce tourniquet pain. [1617] Addition of dexmedetomidine to prilocaine in IVRA decreases pain scores, improves anesthesia quality, decreases analgesic requirement, shortens sensory block onset time, and prolongs sensory block recovery time.…”

Section: Discussionmentioning

confidence: 99%

Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study

Kumar¹,

Sharma²,

Datta³

2012

J Anaesthesiol Clin Pharmacol

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Introduction:Ketamine and dexmedetomidine decrease anesthetic requirement and provide analgesia to patients. We designed this study to compare the effect of dexmedetomidine and ketamine when added to lignocaine in intravenous regional anesthesia (IVRA).Materials and Methods:Seventy two patients undergoing hand surgery were randomly assigned to three groups to receive IVRA. They received 20 ml of 1% lignocaine and either 1 ml of isotonic saline (Group L, n = 24); or 0.5 mg/kg body weight ketamine (Group LK, n = 24) or 1 mcg/kg body weight dexmedetomidine (Group LD, n = 24). Sensory and motor block onset and recovery time were noted. After the tourniquet deflation, pain and sedation values, time to first analgesic requirement and any side effects were noted.Results:Shortened sensory and motor block onset times (69.17 min and 7.83 min respectively, P < 0.0001) and improved quality of anesthesia (satisfaction score = 3, P < 0.05) were found in ketamine group. Visual analog scale scores (3.21 ± 0.41) were comparable while time to first analgesic requirement (166.25 ± 25.89 min, P < 0.0001) was significantly longer in dexmedetomidine group after tourniquet release.Conclusion:We conclude that the addition of 1 mcg/kg of body weight dexmedetomidine or 0.5 mg/kg of body weight ketamine to lignocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects. We considered ketamine reduced the time for onset of block, delayed the onset of tourniquet pain, and reduced postoperative analgesic requirement and had a better patient satisfaction than placebo or dexmedetomidine.

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“…Quality of block was not found to be poor in any cases in either group. Mizrak et al 22 and Shah and Shabir 23 also found quality of blockade statistically better in dexmedetomidine group. As dexmedetomidine is known for its sedative property, we compared both the groups with respect to sedation.…”

Section: Discussionmentioning

confidence: 87%

The Study of Effect of Dexmedetomidine on the Characteristics of Bier’s Block (Intravenous Regional Anaesthesia) When Administered in Addition to Lidocaine for Forearm and Hand Surgeries

Bhaumik¹,

Singam²,

Agrawal³

2016

jebmh

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BACKGROUNDBier's Block (IVRA) is being commonly used as anaesthetic technique for conducting forearm and hand surgeries. It is technically simple and reliable with success rate between 94-98%. However, its use is limited by tourniquet pain and inability to provide postoperative analgesia. To improve the quality of Bier's block, the addition of α-2 adrenergic receptor agonist, dexmedetomidine have been the focus of interest for their sedative, analgesic and perioperative sympatholytic and cardiovascular stabilising effects. The aim of the present study was to evaluate the efficacy of 0.5 mcg/kg dexmedetomidine when added to (0.5%) lidocaine (40 mL) with lidocaine alone in IVRA. MATERIALS AND METHODSAfter approval from Institutional Ethical Committee, 60 patients of ASA Grade I and II of either sex aged between 20-60 years scheduled for various forearm and hand surgeries were included in the study. Patients were randomly divided into two groups 30 in each. Patients in Group L received (0.5%) lidocaine 40 mL with 1 mL NS making it to a total volume of 41 mL and Group LD received (0.5%) lidocaine with the test drug, 0.5 mcg/kg dexmedetomidine diluted up to 1 mL NS to a total volume of 41 mL. Both sensory and motor block onset and regression times, incidences of tourniquet pain, haemodynamic changes, quality of block were noted. Sedation score using Ramsay sedation scale, duration of postoperative analgesia and associated complications were also recorded. Intraoperative and postoperative pain score was recorded by using VAS. Rescue analgesia was given when VAS >3. RESULTSSignificant shorter onset times and prolonged regression times of sensory and motor block were recorded in Group LD as compared to Group L. Better haemodynamic stability, prolonged tourniquet tolerance and improved quality of anaesthesia were found in Group LD. Time to first analgesic requirements was significantly longer in Group LD in the postoperative period. CONCLUSIONWe concluded that addition of 0.5 mcg/kg dexmedetomidine to (0.5%) lidocaine for IVRA improves quality of anaesthesia, tourniquet pain and postoperative analgesia without causing side effects.

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Premedication With Dexmedetomidine Alone or Together With 0.5% Lidocaine for IVRA

Cited by 19 publications

References 26 publications

Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia

Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia

Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study

The Study of Effect of Dexmedetomidine on the Characteristics of Bier’s Block (Intravenous Regional Anaesthesia) When Administered in Addition to Lidocaine for Forearm and Hand Surgeries

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