Randomized Controlled Study of Intravenous Regional Anaesthesia for Forearm & Hand Surgery: Comparison of Lignocaine, Lignocaine with Ketamine & Lignocaine with Dexmedetomidine

Aims & Objectives To evaluate the effect of Dexmedetomidine & Ketamine as an adjuvant to Lignocaine hydrochloride 0.5 % 40ml in IVRA and to assess quality of anaesthesia, postoperative analgesia and side effects for hand or forearm surgery. Material & Method Ninety patients were randomly assigned to three groups to receive IVRA for hand and forearm surgery 40 ml of 0.5 % Lignocaine and either 1 ml of isotonic saline (Group-L) or 0.5mg/kg Ketamine (Group-LK) or 1mcg/kg Dexmedetomidine (Group-LD). Sensory blockade by pin prick method, tourniquet pain by VAS, and sedation by Ramsay score, time to first analgesic, quality of anaesthesia by patient satisfaction score and hemodynamic parameters were assessed. Results and Summary Sensory and motor block onset time (P less than 0.001) was faster in Group LK compared to Group LD and group L but duration of analgesia (pless than0.001) and sedation (pgreater than0.05) was longer in Group LD with better patient satisfaction. Conclusion Onset of sensory (78sec) and motor block (8min) was faster with group LK in IVRA. Both adjuvants prolonged the analgesic effect of Lignocaine in IVRA but it was more with Dexmeditomidine (169min). Patients remained more comfortable and sedated with Dexmeditomidine. Thus in IVRA, addition of Dexmedetomidine or Ketamine to Lignocaine improves quality of anaesthesia and postoperative analgesia without significant side effects.