2014

Ön Kol ve El Cerrahilerinde, Rejyonal İntravenöz Anestezide Lignokaine Deksmedetomidin Eklenmesi: Prospektif, Randomize, Kontrollü Çalışma

Amaç: Rejyonal intravenöz anestezi (RİVA) distal ekstremitelerin kısa süreli cerrahi girişimlerinde kullanılan etkili bir anestezi tekniğidir. Bu tekniğin başlıca kısıtlaması olan intraoperatif turnike ağrısının giderilmesi için çeşitli adjuvanlar kullanılmıştır. Bu çalışmada, lignokaine eklenen sabit düşük dozda deksmedetomidinin intraoperatif turnike ağrısı, blok başlama zamanı ve blok süresi ile hasta memnuniyeti üzerine etkileri araştırılmıştır. Yöntem: Yaklaşık 1 saat süren üst ektremite cerrahisi geçiren ASA I-II risk grubunda 100 yetişkin hasta randomize olarak iki gruba ayrıldı (her grupta n=50). Grup A’ya sadece 35 mL koruyucusuz lignokain grup B’ye 30 μg deksmedetomidin ile birlikte 35 mL koruyucusuz lignokain verildi. Turnike ağrısı sıklığı, intraoperatif fentanil tüketimi, duyusal ve motor blok başlama zamanları ile turnike indirildikten sonra gerileme süreleri, postoperatif sayısal ağrı skoru (NPRS), analjezi süre- si ve genel hasta memnuniyeti not edildi. Bulgular: Turnike ağrısı sıklığı ve intraoperatif fentanil tüketim miktarı Grup B’de anlamlı olarak daha düşüktü. Grup B’de motor ve duyusal blok başlama zamanı daha hızlı ve blok süreleri daha uzundu. Deksmedetomidin grubunda postopertatif NPRS skorları daha düşük, analjezi, süreleri daha uzun ve genel hasta memnuniyeti daha iyiydi. Sonuç: RİVA’da lignokaine adjuvan olarak eklenen 30 μg dozundaki deksmedetomidin, turnike ağrısını ve intraoperatif fentanil tüketimini önemli ölçüde azaltır. Deksmedetomidin eklenmesi, tek başına lignokaine göre blok başlangıcını kısaltır, blok süresini uzatır ve daha tatmin edici bir anestezi sağlar

Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

Objective: Intravenous regional anesthesia (IVRA) is an effective anesthetic technique for surgical procedures of short duration involving the distal parts of the limbs. Intraoperative tourniquet pain is the major restraint of this technique, and to overcome this limitation, various adjuvants to local anesthetics have been used. This study investigated the effect of a fixed low dose of dex- medetomidine as an adjuvant to lignocaine on intraoperative tourniquet pain, onset of block, duration of block, and patient satisfaction. Methods: A total of 100 adult patients with ASA grade I and II who were scheduled for upper limb surgery of approximately 1 hour in duration were randomly divided into two groups (n=50 in each group). Group A received 35 mL of preservative-free lignocaine alone and Group B received 35 mL of preservative-free lignocaine along with 30 μg of dexmedetomidine. The incidence of tourni- quet pain, intraoperative fentanyl consumption, duration of onset and recovery of sensory and motor block after tourniquet deflation, postoperative numeric pain rating scale (NPRS) scores, duration of analgesia, and overall patient satisfaction were noted. Result: The incidence of tourniquet pain and intraoperative fentanyl consumption were signifi- cantly lower in Group B. The onset and duration of sensory and motor blocks were faster and longer, respectively, in Group B. Postoperative NPRS scores were lower, duration of analgesia was longer, and overall patient satisfaction was better in the dexmedetomidine group. Conclusion: Dexmedetomidine at a dose of 30 μg as a lignocaine adjuvant significantly reduces tourniquet pain and intraoperative fentanyl consumption in IVRA. Dexmedetomidine shortens the onset of block, prolongs the duration of block, and provides a more satisfactory anesthesia than lignocaine alone.

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1. Loser B, Petzoldt M, Loser A, Bacon DR, Goerig M. Intravenous regional anesthesia: A historical overview and clinical review. J Anesth Hist. 2019;5:99-108. https://doi.org/10.1016/j.janh.2018.10.007
2. Brown Eli M, McGriff James T, Malinowski, Robert W. Intravenous regional anaesthesia (Bier’s block): review of 20 years’ experience. Can J Anaesth. 1989;36:307-10. https://doi.org/10.1007/BF03010770
3. Nishiyama T. Supraclavicular block vs. intravenous regional anaesthesia for forearm surgery. Anaesthesiol Intensive Ther. 2019;51:17-20. https://doi.org/10.5603/AIT.a2019.0005
4. Yossef IA, Mohamed AZE, Mohamed GF. Different adju- vants to lidocaine in Bier’s block; comparison between ketamine, nitroglycerin, and magnesium. 2017: Egyptian Journal of Anaesthesia. 2017;33:315-21. https://doi.org/10.1016/j.egja.2017.09.002
5. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical proce- dures. Can J Anesth. 2002;49:32-45. https://doi.org/10.1007/BF03020416
6. Lillie PE, Glynn CJ, Fenwick DG. Site of action of intra- venous regional anesthesia. Anesthesiology. 1984;61:507-10. https://doi.org/10.1097/00000542-198411000-00005
7. Ramadhyani U, Park JL, Carollo DS, Waterman RS, Nossaman BD. Dexmedetomidine: clinical application as an adjunct for intravenous regional anesthesia. Anesthesiology Clin. 2010;28:709-22. https://doi.org/10.1016/j.anclin.2010.08.008
8. Esmaoglu A, Mizrak A, Akin A, Turk Y, Boyaci A. Addition of dexmedetomidine to lidocaine for intrave- nous regional anaesthesia. Eur J Anaesthesiol. 2005;22:447-51. https://doi.org/10.1017/S0265021505000761
9. Subramanya V, Kapinigowda ST, Math AT, Chennaiah VB. Dexmedetomidine as an adjuvant for intravenous regional anesthesia in upper limb surgeries. Anesth Essays Res. 2017;11:661-4. https://doi.org/10.4103/0259-1162.206851
10. Memis D, Turan A, Karamanlioglu B, Pamukcu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg. 2004;98:835-40. https://doi.org/10.1213/01.ANE.0000100680.77978.66
11. El-Tahawy M, Shaaban AR, Ahmad A. Comparison between dexmedetomidine and magnesium sulphate as adjuvants for intravenous regional anesthesia. Ain Shams J Anesthesiol. 2015;8:129-33. https://doi.org/10.4103/ 1687-7934.153954
12. Ouchi K. Dexmedetomidine as additive agent for local anesthetics. Glob Anesth Perioper Med. 2015;2. https://doi.org/10.15761/GAPM.1000137
13. Nilekani E, Menezes Y, D’Souza SA. A study on the effi- cacy of the addition of low dose dexmedetomidine as an adjuvant to lignocaine in intravenous regional anaes- thesia (IVRA). J Clin Diagn Res. 2016;10:UC01-UC05. https://doi.org/10.7860/ JCDR/2016/20826.8724
14. Kol IO, Ozturk H, Kaygusuz K, Gursoy S, Comert B, Mimaroglu C. Addition of dexmedetomidine or lor- noxicam to prilocaine in intravenous regional anaes- thesia for hand or forearm surgery: A randomized controlled study. Clin Drug Investig. 2009;29:121-9. https://doi.org/10.2165/0044011-200929020-00006
15. Hassanein A. Dexmedetomidine versus ketorolac as adjuvants for intravenous regional anesthesia. Ain- Shams J Anaesthesiol. 2016;9:92-8. https://doi.org/10.4103/1687-7934-178886
16. Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adreno- ceptor. Anesth Analg. 2008;107:96-101. https://doi.org/10.1213/ane.0b013e318176be73
17. Kosugi T, Mizuta K, Fujita T, Nakashima M, Kumamoto E. High concentrations of dexmedetomidine inhibit compound action potentioals in frog sciatic nerves without alpha (2) adrenoceptor activation. Br J Pharmacol. 2010;160:1662-76. https://doi.org/10.1111/j.1476-5381.2010.00833.x
18. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in com- bination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008;109:502-11. https://doi.org/10.1097/ALN.0b013e318182c26b
19. Sardesai SP, Patil KN, Sarkar A. Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia. Indian J Anaesth. 2015;59:733-8. https://doi.org/10.4103/0019-5049.170034