Comparative study between addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia

Abstract

Intra venous regional anesthesia is simple to administer, reliable, and cost-effective. It is ideal for short operative procedures on the extremities performed on an ambulatory basis. Concerningabout local anesthetic toxicity, slow onset, poor muscle relaxation, tourniquet pain, and minimal postoperative pain relief is considering shortages in the procedure. The ideal IVRA solution should have the following features: rapid onset, low dose of LA, reduced tourniquet pain, and prolonged postoperative analgesia.This may only be achieved by the addition of adjuncts to LA. Several adjuncts have been used including narcotics, nonsteroidal anti-inflammatory drugs, muscle relaxants, α2 agonists and neostigmine. Ketamine exerts a noncompetitive blockade of N-methyl-D-aspartate receptors that play a major role in synaptic plasticity, facilitation of pain processing and are specifically implicated in central nervoussystemTherefore, NMDA receptor antagonists have been implicated in perioperative pain management as they modulate central sensitization induced both by the incision and tissue damage. Dexmedetomidine is an alpha2-adrenergic agonist and produces sedative–hypnotic, analgesic, and anxiolytic effects by an action on alpha2-receptors in the locus ceruleusin the pons . In the present study we aim to compare addition of ketamine orDexmedetomidineto lignocaineas adjuvants for intra venous local anesthesia on patient hemodynamics,mean arterial blood pressure(MAP), heart rate (HR),peripheral oxygen saturation (SpO2),onset of sensory and motor bock ,need of intraoperative analgesia,Satisfaction score Time to 1st postoperative Analgesia,post-operative pain scoreand Sedation score. We compared our present study by other studies carried to compare between the effect of ketamine or Dexmedetomidineas adjuvantto lignocaine for IVRA. Some results matched with our present results and some not matched with. The results of the present study showed stable patient hemodynamics throughout the procedure, need of intraoperative analgesia,post-operative pain score were the same in both groups. Faster sensory and motor block, satisfactionin group lignocaine and ketamine, but sedationwas prolonged in group lignocaine and Dexmedetomidine.