Comparison between Dexmedetomidine and Midazolam as an Adjuvant to Lidocaine in Intravenous Regional Anesthesia for below Elbow Surgeries

Background: Intravenous regional anesthesia (IVRA) is safe, technically simple but it has several disadvantages as limited duration, lack of postoperative analgesia and tourniquet pain. Aim of the study: Comparing the effect of addition of dexmedetomidine and midazolam to lidocaine on the characters of the produced intravenous regional anesthesia for below elbow surgeries. Patients and methods: Sixty patients of both sexes admitted for forearm and hand surgeries were randomly allocated into three equal groups: Lidocaine group (L group) received 40 ml of 0.5% lidocaine, Lidocaine/ Dexmedetomidine group (L/D group) received 40 ml of 0.5% lidocaine plus 0.5μg/kg dexmedetomidine and Lidocaine/Midazolam group (L/M group) received 40 ml of 0.5% lidocaine plus 50 μg/kg midazolam. Onset and offset of sensory and motor blocks, intraopetrative analgesic potency and tourniquet pain, time to ask for the 1st post-operative analgesia, the consumed amount of postoperative analgesia and the associated side effects were detected and recorded. Results: Both Dexmedetomidine and midazolam enhanced the onset of sensory block, only midazolam enhanced the onset of motor block, both lowered the mean of surgical pain scores, decreased the intraoperative fentanyl consumption, delayed the onset of tourniquet pain, and prolonged postoperative analgesia with minimal side effects. Conclusion: Addition of each of dexmedetomidine and midazolam to lidocaine for IVRA, significantly improved the quality of the produced regional anesthesia.