Lidocaine-tramadol versus lidocaine-dexmedetomidine for intravenous regional anesthesia

BackgroundIntravenous regional anesthesia (IVRA) has been used for more than a century. Both tramadol (synthetic opioid) and dexmedetomidine (α₂-agonist) can act locally.Aim of the workTo compare effects of adding tramadol versus dexmedetomidine to lidocaine during IVRA.Patients and methodsSixty patients were randomly assigned into: Group C (n = 20), Group T (n = 20), and Group D (n = 20). All patients received 3 mg/kg 0.5% lidocaine [+100 mg tramadol in Group T, or 1 μg/kg dexmedetomidine in Group D]. Times of onset and offset of sensory and motor blocks, and time to tourniquet pain were recorded. Postoperative VAS score, time to first dose, and total amounts of supplementary analgesia (Paracetamol) were recorded. Sedation was evaluated using Ramsay sedation scale (RSS).ResultsSignificantly shorter onset times and longer recovery times of sensory and motor block were recorded in Groups T and D compared to Group C (P < 0.05); while, with no significant differences between Groups T and D. Delayed onset of tourniquet pain occurred in Groups T and D compared to Group C (P < 0.05) with no significant differences between Groups T and D. Fourteen patients required fentanyl to control tourniquet pain in Group C compared to (5 and 4) in Groups T and D respectively. Significantly lower Postoperative VAS score, longer time to first dose and lower consumption of Paracetamol were recorded in Groups T and D than in Group C; with no significant differences between Groups T and D. Complications were skin rash in 30% of patients in Group T, bradycardia and sedation in 35% and 65% of patients in Group D respectively.ConclusionAddition of either tramadol or dexmedetomidine enhances lidocaine during IVRA with higher incidence of skin rash with tramadol and postoperative bradycardia and sedation with dexmedetomidine.