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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 15, Issue 2, June 2015 pp 283-286
Anesthetic efficacy of dexmedetomidine and acetaminophen in intravenous regional anesthesia
Mukta Jitendra1, Monika Dabgotra2, Rajesh Mahajan3, Smriti Gulati4
1Associate professor, 2PG Student, 3Assistant Professor, 4Professor, Department of Anaesthesiology, Government Medical College, Jammu, Jammu & Kashmir, INDIA.
Introduction: The ideal intravenous regional anesthesia solution should have the following features: rapid onset reduced tourniquet pain and prolonged post-deflation analgesia, local anesthetics alone are not able to bestow all such attributes to the IVRA solutions; hence multiple adjuncts like opioids, tramadol, nonsteriodal anti-inflammatory drug, clonidine, dexmedetomidine, muscle relaxants, potassium, magnesium, ketamine and alkalinisation with sodium bicarbonate have been used to improve the overall quality of anesthesia and analgesia. Aims and objective: To evaluate the anesthetic effectiveness of dexmedetomidine and acetaminophen when administered as adjuncts to lidocaine in intravenous regional anesthesia. Materials and method: The present study was undertaken in the department of anesthesiology and intensive care in government medical college, Jammu. It comprised of 90 healthy adult patients of either sex, not having any systemic illness, who were scheduled for hand or forearm surgery and they were divided into three groups of thirty patients each. After appropriate premedication, the patients in Group I was given intravenous regional anesthesia with 10ml of preservative free lidocaine 2% diluted with normal saline to a total volume of 40 ml. Group II patients were given intravenous regional anaesthesia with 10 ml of preservative free lidocaine 2% mixed with 0.5 ug/kg of dexmedetomidine diluted with normal saline to make a total volume of 40 ml. Group III patient were given intravenous regional anaesthesia with 10 ml of preservative free lidocaine 2% mixed with 30ml (300mg) of paracetamol (acetaminophen) to total volume of 40 ml. The onset of sensory and motor block in minutes was recorded. Intra-operative degree of analgesia was evaluated on the basis of visual analogue scale (VAS) (0=no pain and 10 = ‘worst pain imaginable’). Quality of intraoperative anesthesia was assessed as per following scale: Excellent (4): no complaint from the patient. Good (3): minor complaint with no need of supplemental analgesics. Moderate (2): complaint that required supplemental analgesic. Results: All the three groups were comparable in age and weight distribution and there was statistically insignificant difference among them. The addition of 0.5ug/kg of dexmedetomidine to lidocaine for IVRA shortened the onset of sensory and motor block and improved the quality of anaesthesia. The addition of 300mg of acetaminophen to lidocaine for IVRA only shortened the onset of sensory block without affecting the motor block onset time. There was improved quality of anesthesia. Sensory and motor block recovery times were not affected but there was significantly increased duration of postoperative analgesia and negligible side effects. In group II, 28(93.3%) patients had excellent quality of anesthesia score, 2(6.6%) had good quality of anesthesia score. In group III, 20(66.6%) patients had excellent quality of anesthesia score, 15(50%) had good quality of anesthesia score, and 5 (16.6%) had moderate quality of anesthesia score. In group II and III, no patient had moderate score. Conclusion: Thus we conclude that the addition of dexmedetomidine or acetaminophen to lidocaine in intravenous regional anesthesia definitely improve the quality of anesthesia and analgesia to a variable extent. However, dexmedetomidine is more potent, and provides better quality of anesthesia and analgesia.