Atracurium with or without Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia in Upper Limb Surgeries

Background: The use of adjuvants in intravenous regional anesthesia [IVRA] for upper limb surgeries seems to increase efficacy and reduce side effects. Trials are continued to reach the ideal combination. Aim of the work: The study aimed to evaluate the efficacy and safety of IVRA for upper arm surgery using different adjuvants [atracurium and dexmedetomidine]. Patients and methods: 120 patients scheduled for elective upper limb surgeries were included. Patients were divided randomly into four equal groups. Group I received 40 ml lignocaine 0.5% alone, group II: received 40 ml [lignocaine 0.25% plus dexmedetomidine 50 μg], group III received 40 ml [lignocaine 0.25% plus atracurium 2 mg], and group IV received 40 ml [[lignocaine 0.25% plus dexmedetomidine 50 μg and atracurium 2 mg]. surgery duration, quality of anesthesia, postoperative analgesia, and hemodynamics were monitored. Results:The onset of sensory and motor block was significantly shorter in groups II and IV than in group I or III. Also, both sensory and motor block were significantly shorter in group IV when compared to group II [2.53±0.57, 3.60±0.62 vs. 3.33±0.54 and 5.20±0.84 respectively].  Besides, the pain was significantly lower in groups II and IV than groups I or III after deflation at 5, 15, 30, 60 minutes, and up to 8 hours.  The need for postoperative analgesia was significantly higher among groups I and III when compared to groups II and IV [56.7%, 63.3% vs. 30.0% and 20.0%, respectively]. No major adverse events were reported. Conclusion: The use of dexmedetomidine as an adjuvant had a significantly better postoperative analgesia, longer duration of sensory and motor block, and earlier onset of action. In addition, the use of atracurium besides dexmedetomidine improves the quality of IVRA.