scholarly journals Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

2021 ◽  
Author(s):  
Moumita Roychowdhury ◽  
Anjum Naz
Keyword(s):  
Patient Satisfaction ◽  
Regional Anesthesia ◽  
Rating Scale ◽  
Controlled Study ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Upper Limb Surgery ◽  
Fentanyl Consumption ◽  
Group B ◽  
Preservative Free

Objective: Intravenous regional anesthesia (IVRA) is an effective anesthetic technique for surgical procedures of short duration involving the distal parts of the limbs. Intraoperative tourniquet pain is the major restraint of this technique, and to overcome this limitation, various adjuvants to local anesthetics have been used. This study investigated the effect of a fixed low dose of dexmedetomidine as an adjuvant to lignocaine on intraoperative tourniquet pain, onset of block, duration of block, and patient satisfaction. Methods: A total of 100 adult patients with ASA grade I and II who were scheduled for upper limb surgery of approximately 1 hour in duration were randomly divided into two groups (n=50 in each group). Group A received 35 mL of preservative-free lignocaine alone and Group B received 35 mL of preservative-free lignocaine along with 30 μg of dexmedetomidine. The incidence of tourniquet pain, intraoperative fentanyl consumption, duration of onset and recovery of sensory and motor block after tourniquet deflation, postoperative numeric pain rating scale (NPRS) scores, duration of analgesia, and overall patient satisfaction were noted. Result: The incidence of tourniquet pain and intraoperative fentanyl consumption were significantly lower in Group B. The onset and duration of sensory and motor blocks were faster and longer, respectively, in Group B. Postoperative NPRS scores were lower, duration of analgesia was longer, and overall patient satisfaction was better in the dexmedetomidine group. Conclusion: Dexmedetomidine at a dose of 30 μg as a lignocaine adjuvant significantly reduces tourniquet pain and intraoperative fentanyl consumption in IVRA. Dexmedetomidine shortens the onset of block, prolongs the duration of block, and provides a more satisfactory anesthesia than lignocaine alone.

scholarly journals Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study

2020 ◽  
Author(s):  
Hong Chen ◽  
Bin Wang ◽  
Qin Li ◽  
Juan Zhou ◽  
Rui Li ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Patient Satisfaction ◽  
General Anesthesia ◽  
Normal Saline ◽  
Rating Scale ◽  
Intravesical Instillation ◽  
Controlled Study ◽  
Control Group ◽  
Post Operation ◽  
Male Patients

Abstract Background: The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia.Methods: This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results: CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p<0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p<0.001). No differences were detected in Steward score out of PACU (p=0.213) and from the time of the end of operation to fully awake (p=0.417).Conclusion: Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia.Clinical Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018

Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 24 (04) ◽  
pp. 469-476 ◽  
Author(s):  
Ted Matthew P. Evangelista ◽  
John Hubert C. Pua ◽  
Mara Therese P. Evangelista-Huber
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Confidence Interval ◽  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Random Effects ◽  
Complication Rates ◽  
Pain Scores ◽  
Intravenous Regional Anesthesia ◽  
Post Operative Pain

Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% confidence interval 0.46 to 3.67 minutes, p = 0.01, I2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference −2.40, 95% confidence interval −3.41 to −1.38, p < 0.00001; I2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled risk ratio 0.98, 95% confidence interval 0.93 to 1.03, p = 0.36, I2 0%, p = 0.64) and complication rates (random effects, pooled risk ratio 0.40, 95% confidence interval 0.07 to 2.18, p = 0.29, I2 60% p = 0.08) between WALANT versus conventional methods. Conclusions: The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.

scholarly journals Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hong Chen ◽  
Bin Wang ◽  
Qin Li ◽  
Juan Zhou ◽  
Rui Li ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
General Anesthesia ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intravesical Instillation ◽  
Controlled Study ◽  
Control Group ◽  
Post Operation ◽  
Male Patients

Abstract Background The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia. Methods This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p < 0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p < 0.001). No differences were detected in Steward score out of PACU (p = 0.213) and from the time of the end of operation to fully awake (p = 0.417). Conclusion Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia. Trial registration Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018.

Bilateral Intravenous Regional Anesthesia

2003 ◽  
Vol 98 (6) ◽  
pp. 1427-1430 ◽  
Author(s):  
Maximilian W.B. Hartmannsgruber ◽  
Sabine Plessmann ◽  
Peter G. Atanassoff
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effects ◽  
Regional Anesthesia ◽  
Normal Saline ◽  
Drug Combinations ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Study Session ◽  
Tourniquet Release

Background Ketorolac, when added to lidocaine, has been shown to reduce early tourniquet pain during intravenous regional anesthesia (i.v.RA) in patients. Although the effectiveness of ropivacaine 0.2% for i.v.RA is equal to that of lidocaine 0.5% but significantly reduces central nervous system side effects after release of the tourniquet, it provides no advantage with regard to tourniquet tolerance times. Simultaneous bilateral i.v.RA with ropivacaine 0.2% was used to test the hypothesis that ketorolac modifies tourniquet tolerance and to test whether drug combinations can be evaluated in one study session. Methods Ten healthy, unsedated volunteers received 30 ml of ropivacaine 0.2% in each upper arm with 2 ml of normal saline in one arm and 30 mg of ketorolac in the contralateral arm for i.v.RA. Both proximal tourniquets remained inflated for 30 min, followed by inflation of the distal tourniquets and release of the proximal ones. Verbal numeric scores for tourniquet pain were recorded for both extremities. Central nervous system side effects were graded after release of each distal tourniquet. Results There was no difference between the two upper extremities with regard to surgical anesthesia and tourniquet tolerance. Total tourniquet tolerance was a median of 58.5 min (range, 45-90 min) and 60.5 min (39-79 min) in the normal saline and ketorolac groups, respectively. After release of the distal tourniquets, 5 of 10 volunteers experienced mild dizziness. Conclusions The addition of ketorolac to ropivacaine does not improve tourniquet tolerance. Minimal central nervous system side effects after tourniquet release suggest that a total of 60 ml ropivacaine 0.2% for bilateral i.v.RA is a useful model for comparison of i.v.RA drug combinations.

Intravenous regional anesthesia or ultrasound-guided infraclaviculer block for upper limb surgery

2014 ◽  
Vol 31 ◽  
pp. 129
Author(s):  
S. Zubeyir ◽  
G. Turan ◽  
R. Cetiner ◽  
D. Subasi ◽  
A. Ozgultekin ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Upper Limb ◽  
Ultrasound Guided ◽  
Intravenous Regional Anesthesia ◽  
Upper Limb Surgery

scholarly journals Comparison Between Abdominoplasty Assisted by Liposuction Utilizing Classical (U) Incision Versus (W) Incision: A Randomized Controlled Study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Abdrabo ◽  
M G Elsayed ◽  
A M A Kabeel
Keyword(s):  
Patient Satisfaction ◽  
Body Contouring ◽  
Wound Dehiscence ◽  
Controlled Study ◽  
Moderate Amount ◽  
Excess Skin ◽  
Objective Feedback ◽  
Prospective Comparative Study ◽  
The Aesthetic ◽  
Group B

Abstract Background Traditional abdominoplasty techniques, which use primarily transverse incisions, seem to be most beneficial for those patients whose abdominal contour is relatively normal with only a minimal to moderate amount of flaccid skin. Objective The aim of the study was to compare between the results of two different incisions used in abdominoplasty with liposuction, and to detect the morbidities and complications which may occur after the surgical procedures such as Aesthetic complication which occured in the form of asymmetry, dog ears, residual deformity, unsatisfactory umbilicus and unsatisfactory scarring (widened, thickened, hypertrophic or keloid) and Non-aesthetic complications which occurred in the form of seroma, wound infection, partial skin necrosis, and wound dehiscence. In addition to comparing the aesthetic outcome and patient satisfaction. Patients and Methods The contour of the abdomen is the backbone of body contouring surgery. Patients usually seek abdominoplasty for abdominal wall laxity, excess skin, striae, or diastasis of the rectus muscles. The inevitable end scar must be invisible as possible, symmetrical, and located in regions covered with the minimal clothing. The study included 30 patients divided into 2 groups (A) & (B) each group consist of 15 patients. This study was a prospective comparative study between Classic (U) incision abdominoplasty and (W) incision abdominoplasty; Group (A) undergone Classic (U) incision abdominoplasty, and Group (B) undergone (W) incision abdominoplasty. Results: received from both groups were compared to each other and the collected results were evaluated, and subjected to statistical analysis . Patient satisfaction was assessed by direct patient questioning and included subjective and objective feedback on the overall satisfaction following abdominoplasty, areas of dissatisfaction and patients satisfaction post different types of abdominoplasty. Conclusion Abdominoplasty with Liposuction provide high levels of patient satisfaction. The combined procedure is similar in discomfort level to abdominoplasty alone and produces the highest level of patient satisfaction and the patient satisfaction represents a golden goal in the practical work.

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