Synergistic effects of Paracetamol and Dexamethasone with Lidocaine in Intravenous regional anesthesia (IVRA) of upper limbs: A randomized clinical trial

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

able 1 Demographic particulars and statistical indices of intra operational variables in the 4 groups of subjects.

Group	L	L + D	L + P	L + D + P	P value
Number	15	15	15	15
Sex: M/F	8/7	8/7	8/7	7/8	P > 0.05
Age	41.3 ± 3.5	29.1 ± 1.7	36.2 ± 3.5	36 ± 3.9	P > 0.05
Weight (kg)	61.6 ± 1.1	70.8 ± 2.6	68.3 ± 3.3	65.6 ± 3.6	P > 0.05
Height (cm)	164.6 ± 1.2	171.6 ± 2.4	166.5 ± 2.8	170.5 ± 1.7	P > 0.05
Mean intra operational systolic BP	132.3 ± 1.8	127.3 ± 4	133 ± 1.4	131.4 ± 2.2	P > 0.05
Mean intra operational diastolic BP	87.3 ± 0.6	86.2 ± 1.5	84.9 ± 0.4	84 ± 1.1	P > 0.05
Mean intra operational heart rate	74.4 ± 0.9	76.9 ± 1.1	77.6 ± 1.4	79 ± 0.6	P > 0.05

P > 0.05: no statistically significant difference.

able 2 Percentage of analgesic requirement and statistical indices of VAS during the first 24 h past the operation in the 4 groups of subjects.

Group	L	L + D	L + P	L + D + P	P value
VAS (during the operation)	2.7 ± 1.2	2.1 ± 0.9^∗	2.06 ± 0.8^∗	1.84 ± 0.8^∗∗×Ϯ
VAS (4 h past)	4.6 ± 0.8	3.8 ± 0.8^∗	3.7 ± 0.7^∗	3.2 ± 0.7^∗∗×Ϯ
VAS (6 h past)	3.8 ± 0.4	3.3 ± 0.4^∗	3.4 ± 0.5^∗	3 ± 0.3^∗∗×Ϯ
VAS (12 h past)	2.7 ± 0.4	2.6 ± 0.5	2.6 ± 0.5	2.5 ± 0.5	P > 0.05
VAS (24 h past)	1.4 ± 0.5	1.3 ± 0.4	1.2 ± 0.4	1.2 ± 0.4	P > 0.05
VAS (overall 24 h)	3.15 ± 1.3	2.7 ± 1.09	2.75 ± 1.09	2.5 ± 0.9	P > 0.05
Percentage of analgesic requirement	73%	60%^∗	53%^∗	40%^∗∗×Ϯ

^∗∗p < 0.01, ^∗p < 0.05: significant difference with the (L) group.

^×p < 0.05: difference with the (L + P) group.

^Ϯp < 0.05: difference with the (L + P) group.

able 3 Comparison of the mean and standard deviation of onset of sensory and motor nerve blocks, Tourniquet associated pain and duration of anesthesia in the 4 groups of patients.

Group	L	L + D	L + P	L + D + P
Onset of sensory block (min)	5.2 ± 0.7	3.2 ± 0.4^∗∗∗	3.2 ± 0.4^∗∗∗	1.86 ± 0.5^∗∗∗∗××ϮϮ
Onset of motor block (min)	7.3±0.8	5.3±0.4^∗∗∗	5.4±0.5^∗∗∗	3.4±0.5^∗∗∗∗××ϮϮ
Onset of tourniquet associated pain (min)	22 ± 1.6	27.6 ± 1.2^∗∗	27.8 ± 1.1^∗∗	35.4 ± 1.9^∗∗∗××ϮϮ
Duration of anesthesia (min)	43±2.3	47.9±2.6^∗	47.6±1.5^∗	63±2.3^∗∗×Ϯ

^∗∗∗p < 0.001, ^∗∗∗∗p < 0.0001, ^∗∗p < 0.01, ^∗p < 0.05: denoting difference with the (L) group.

^××p<0.01, ^×p < 0.05: denoting difference with the (L+D) group.

^ϮϮp < 0.01, ^Ϯp < 0.05: denoting difference with the (L + P) group.

igure 1 The quality of analgesia in the 4 groups of patients that were anesthetized solely with Lidocaine (L), Lidocaine + Dexamethasone (L + D). Lidocain + Paracetamol (L + P) and Lidocain + Paracetamol + Dexamethasone (L + P + D).