El-Khateeb, S., Nouh, E., Ali, M. (2019). Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries. The Egyptian Journal of Hospital Medicine, 76(1), 3373-3379. doi: 10.21608/ejhm.2019.36901
Saad El-Deen Mahmoud El-Khateeb; El-Desoky Mohammed Ibraheem Nouh; Mohammed Abd-Elsalam Abd-Allah Ali. "Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries". The Egyptian Journal of Hospital Medicine, 76, 1, 2019, 3373-3379. doi: 10.21608/ejhm.2019.36901
El-Khateeb, S., Nouh, E., Ali, M. (2019). 'Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries', The Egyptian Journal of Hospital Medicine, 76(1), pp. 3373-3379. doi: 10.21608/ejhm.2019.36901
El-Khateeb, S., Nouh, E., Ali, M. Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries. The Egyptian Journal of Hospital Medicine, 2019; 76(1): 3373-3379. doi: 10.21608/ejhm.2019.36901
Effect of Paracetamol and Dexamethasone with Lidocaine in Intravenous Regional Anesthesia of Upper Limb Surgeries
Department of Anaesthesiology and Intensive Care, Faculty of Medicine – Al-Azhar University
Abstract
Background: Upper limb surgeries may be done under general anaesthesia or other methods such as nerve block or regional anaesthesia such as intravenous regional anesthesia (IVRA). Intravenous regional anesthesia has many advantages such as cost effectiveness, day case surgeries and reduced hemorrhage risk. Objective: The primary objective was to evaluate the effect of paracetamol and dexamethasone when combined with lidocaine on the depth and duration of IVR anesthesia in upper limbs. The secondary objective was to evaluate the onset of tourniquet-associated pain, time of 1st analgesic request, total opioid consumption and haemodynamic stability. Patients and Methods: Patients of this study were classified into 4 groups, 1 st group received 3 mg/kg lidocaine 2% completed by normal saline to 40 cc total volume without any additives and named as group L. 2 nd group received 3 mg/kg lidocaine 2% plus 8 mg dexamethason completed by normal saline to 40 cc total volume and named as group D. 3 rd group received 3 mg/kg lidocaine 2% plus 250 mg paracetamol completed to 40 cc total volume and named as group P. 4th group received 3 mg/kg lidocaine 2% plus 8 mg dexamethasone plus 250 mg paracetamol completed to 40cc total volume and named as group LDP. These groups were evaluated for haemodynamics and onset of sensory and motor block and time of recovery of sensory and motor block as well as intraoperative VAS score and fentanyl consumption. Results: As regard average values of intraoperative VAS, 4 th group had the lowest numbers then 2nd group, 3 rd group then 1st group which had the highest numbers. As regard the time to 1st analgesic request, the 1 st group showed the shortest time meanwhile the 4 th group showed the longest time to 1st analgesic request while 2 nd and 3rd groups were in between. Total opioid consumption was the least among the 4th group in comparison with the other three groups especially the 1st one, which showed the highest consumption. Finally, 4 th group proved to be the best one as regarding good anaesthesia and analgesia and reduction in intraoperative pain score as well as reduction in opioid consumption. Conclusion: Paracetamol and dexamethasone when combined to lidocaine in intravenous regional anaesthesia in upper limb produce synergistic effect on sensory and motor block, reduce intraoperative pain score and decrease amount of intra operative opioid consumption.
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