Comparison of Lidocaine Alone Versus Lidocaine with Dexmedetomidine for Intravenous Regional Anesthesia
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/005Keywords:
Dexmedetomidine, Lidocaine, Anesthesia Conduction, Pain PostoperativeAbstract
Background: Intravenous regional anesthesia (IVRA) is an efficient method of short limb surgery but often provides limited pain relief in the postoperative period. Dexmedetomidine is an α2-adrenergic agonist that can potentially improve local anesthetic effects, but there is limited evidence in Pakistan because of its previous unavailability. This study aimed to compare lidocaine alone and lidocaine combined with dexmedetomidine IVRA in below-elbow surgery.
Methods: This randomized control study was conducted at Fatima Memorial Hospital, Lahore, from September 3, 2024, to March 2, 2025. 90 ASA I-II patients, aged 18-60 years, who were undergoing elective upper limb surgery, were randomly assigned to two groups. Group A received regional anesthesia with 40ml of lignocaine 0.5%, while Group B received (Bier's Block) the same lignocaine with 0.5µg/kg dexmedetomidine. Tourniquet pain after 2 hours and anesthesia duration were noted. Data were analyzed using SPSS v25.0 with a p-value ≤0.05 as statistically significant.
Results: The Lidocaine plus Dexmedetomidine group showed significantly lower mean pain scores (1.49 ± 0.506) compared to the Lidocaine alone group (2.78 ± 0.704) with a p-value of 0.001. The duration of analgesia was significantly extended in the combination group (190.82 ± 33.71 minutes) when compared to the Lidocaine-alone group (145.73 ± 13.23 minutes), also with a p-value of 0.001.
Conclusion: The combination of dexmedetomidine with lidocaine during IVRA is highly effective in enhancing postoperative analgesia and pain reduction that may lead to an efficient intervention to perform perioperative pain management during upper limb surgery.
References
1. Garcia, Eva R. "Complications of loco‐regional anesthesia." Complic. Equine Surg. 2021 Apr 23: 118-134. doi.org/10.1002/9781119190332.ch14.
2. Marhofer P, Halm J, Feigl GC, Schepers T, Hollmann MW. Regional Anesthesia and Compartment Syndrome. Anesth Analg. 2021 Nov 1;133(5):1348-1352. doi: 10.1213/ANE.0000000000005661.
3. Hassan TE, Botros AR, Nasr YM, El-Sayed Hassan El-Sayed T. Effect of dexmedetomidine as adjuvant to lidocaine in intravenous regional anaesthesia for below elbow surgeries.ZUMJ. 2021 Nov 1;27(6):1485–93. doi: 10.21608/zumj.2019.16492.1481.
4. Liu X, Li Y, Kang L, Wang Q. Recent Advances in the Clinical Value and Potential of Dexmedetomidine. J Inflamm Res. 2021 Dec 30;14:7507-7527. doi: 10.2147/JIR.S346089.
5. Bajpai V, Patel TK, Dwivedi P, Bajpai A, Gupta A, Gangwar P, et al. Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials. Braz J Anesthesiol. 2023 Sep-Oct;73(5):665-675. doi: 10.1016/j.bjane.2022.07.005.
6. Chen Z, Liu Z, Feng C, Jin Y, Zhao X. Dexmedetomidine as an Adjuvant in Peripheral Nerve Block. Drug Des Devel Ther. 2023 May 17;17:1463-1484. doi: 10.2147/DDDT.S405294.
7. Rao S, Rajan N. Dexmedetomidine as an Adjunct for Regional Anesthetic Nerve Blocks. Curr Pain Headache Rep. 2021 Feb 3;25(2):8. doi: 10.1007/s11916-020-00926-z.
8. Gu S, Luo Q, Wen C, Zhang Y, Liu L, Liu L, et al. Application of Advanced Technologies-Nanotechnology, Genomics Technology, and 3D Printing Technology-In Precision Anesthesia: A Comprehensive Narrative Review. Pharmaceutics. 2023 Sep 6;15(9):2289. doi: 10.3390/pharmaceutics15092289.
9. Diniz DA, França AJ, Laureano-Filho JR, Pellizzer EP, Moraes SL, Vasconcelos BC. The influence of Dexmedetomidine as an additive to local anesthetics in dental procedures: A systematic review. Med Oral Patol Oral Cir Bucal. 2025 Mar 1;30(2):e160-e169. doi: 10.4317/medoral.26439.
10. Fernández Martin MT, Alvarez Lopez S, Aldecoa Alvarez-Santullano C. Role of adjuvants in regional anesthesia: A systematic review. Rev Esp Anestesiol Reanim (Engl Ed). 2023 Feb;70(2):97-107. doi: 10.1016/j.redare.2021.06.006.
11. Sane S, Shokouhi S, Golabi P, Rezaeian M, Kazemi Haki B. The Effect of Dexmedetomidine in Combination with Bupivacaine on Sensory and Motor Block Time and Pain Score in Supraclavicular Block. Pain Res Manag. 2021 Apr 10;2021:8858312. doi: 10.1155/2021/8858312.
12. Madan K, Sriram RB, Madan K, Sriram RB. Pain Management in Enhanced Recovery after Emergency Surgery. J. Pain Res. 2023 Feb 16. doi: 10.5772/intechopen.110180.
13. Guler A, Senol YC, Neurosurg AJ. Comparison of Surgical Time and Clinical Outcomes for Intravenous Regional Anesthesia (IVRA) versus Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Open Carpal Tunnel Release Surgery: A Comparative Study. Asian J Neurosurg. 2025 Apr 16. doi: 10.1055/s-0045-1807760
14. Walsh TS, Parker RA, Aitken LM, McKenzie CA, Emerson L, Boyd J, et al. A2B Trial Investigators. Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients: The A2B Randomized Clinical Trial. JAMA. 2025 May 19:e257200. doi: 10.1001/jama.2025.7200.
15. Jiang J, Shen H, Zhang J, Wu Z, Shao X, Cui J, et al. Comparative Study of the Adverse Events Associated With Adjuvant Use of Dexmedetomidine and Clonidine in Local Anesthesia. Front Med (Lausanne). 2021 Jun 24;8:602966. doi: 10.3389/fmed.2021.602966.
16. Kabi S, Verma R, Singh D, Singh P, Agarwal J, Kushwaha BB, et al. A Comparison Between Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Labour Analgesia. Cureus. 2021 Dec 7;13(12):e20237. doi: 10.7759/cureus.20237. PMID: 35004052;
17. Xu S, Hu S, Ju X, Li Y, Li Q, Wang S. Effects of intravenous lidocaine, dexmedetomidine, and their combination on IL-1, IL-6 and TNF-α in patients undergoing laparoscopic hysterectomy: a prospective, randomized controlled trial. BMC Anesthesiol. 2021 Jan 6;21(1):3. doi: 10.1186/s12871-020-01219-z.
18. Doo AR, Lee H, Baek SJ, Lee J. Dexmedetomidine-induced hemodynamic instability in patients undergoing orthopedic upper limb surgery under brachial plexus block: a retrospective study. BMC Anesthesiol. 2021 Sep 16;21(1):207. doi: 10.1186/s12871-021-01416-4.
19. Weber V, Abbott TEF, Ackland GL. Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis. Br J Anaesth. 2021 Mar;126(3):608-621. doi: 10.1016/j.bja.2020.09.048.
20. Saber H, Ali M, Sayed Gad G, Fayed HM. A comparative study of clonidine and magnesium sulfate premedication on perioperative hormonal stress responses, hemodynamic stability and postoperative analgesia in patients with gallbladder diseases undergoing laparoscopic cholecystectomy. A randomized, double-blind, controlled study. Egypt J Anaesth. 2022 Dec 31;38(1):108–15. doi: TEJA-2020-0025
21. Karmaniolou I, Staikou C, Surda P. The Role of Dexmedetomidine as an Additive to Intravenous Regional Anesthesia: A Systematic Review and Meta-analysis. Balkan Med J. 2021 May;38(3):156-164. doi: 10.5152/balkanmedj.2021.20076.
22. Lu Y, Gu Y, Liu L, Tang X, Xia Q, Xu Z. Intravenous Dexmedetomidine Administration Prior Anesthesia Induction With Propofol at 4°C Attenuates Propofol Injection Pain: A Double-Blind, Randomized, Placebo-Controlled Trial. Front Med (Lausanne). 2021 May 7;8:590465. doi: 10.3389/fmed.2021.590465.
23. Xu SQ, Li YH, Wang SB, Hu SH, Ju X, Xiao JB. Effects of intravenous lidocaine, dexmedetomidine and their combination on postoperative pain and bowel function recovery after abdominal hysterectomy. Minerva Anestesiol. 2017 Jul;83(7):685-694. doi: 10.23736/S0375-9393.16.11472-5.
24. Mansour MS, Kom SE, Ahmed M, Rady A, Sadik S. Comparison of Two Different Doses of Dexmedetomidine Added to Lignocaine in Patients Posted for Upper Limb Orthopedic Surgery Under Intravenous Regional Anaesthesia. Rom J Anaesth Intensive Care. 2022 Dec 29;28(2):63-70. doi: 10.2478/rjaic-2021-0011.
25. Olmos AV, Steen S, Boscardin CK, Chang JM, Manahan G, Little AR, et al. Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department. BMJ Open Qual. 2021 Jul;10(3):e001320. doi: 10.1136/bmjoq-2020-001320.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
