Abstract

Ketamine and dexmedetomidine decrease anesthetic requirement and provide analgesia to patients.
Aims: We designed this study to compare the effect of dexmedetomidine and ketamine when added to lignocaine in intravenous regional anesthesia (IVRA).
Methods and Material: Sixty patients undergoing hand surgery were randomly assigned to three group (each n=20) to receive IVRA. Group (I) control group received 3 mg/kg lidocaine 2% with maximum dose of 200 mg diluted to 40 ml with 0.9% saline. Group (II) ketamine group received 3 mg/kg lidocaine 2% with maximum dose of 200 mg plus 0.1 mg/kg ketamine diluted to 40 ml with 0.9% saline. Group (III) dexmedetomidine group received 3 mg/kg lidocaine 2% with maximum dose of 200 mg plus 0.5mcg/kg dexmedetomidine diluted to 40 ml with 0.9% saline. 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 (2.3 min and 3.1 min respectively, P < 0.0001 for group II, 2.2 min and 3.0 min respectively, P < 0.0001 for group III) and improved quality of anesthesia (satisfaction score = 2.8 and 2.9, P < 0.05) were found in group II & III. Visual analog scale scores (3.15 & 3.13, P<0.0001) were comparable while time to first analgesic requirement (168.15min & 212.30 min, P < 0.0001) was significantly longer in group II & III after tourniquet release.
Conclusions: We conclude that the addition of 0.5 mcg/kg of body weight dexmedetomidine or 0.1 mg/kg of body weight ketamine to lignocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects. We considered adjuvants like ketamine and dexmedetomidine 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 only lidocaine