ABSTRACT : To increase tourniquet tolerance , prolong duration of post deflation analgesia.

METHODS :comparision of two groups with different doses of dexmedetomidine

RESULTS : Group b with higher dexem dose had better quality of anaesthesia and analgesia and tourniquet tolerance.

CONCLUSIONS :Dexem can be added to lidocaine to decrease the volume of local anaesthetic for all its beneficial effects.

WITH LIDOCAINE FOR BIERS BLOCK .

BACKGROUND : This study was designed to compare the effects of adding two different doses of dexmedetomidine to lidocaine during Bier`s block. Forty ASA I or II patients scheduled for elective upper limb body surface surgery under Bier`s block were recruited. Bier`s block was achieved using lidocaine 1ml/kg adding dexmedetomidine 0.25 μg kg-1in a group of twenty patients and lidocaine 0.5ml/kg with dexmedetomedine 0.5 μg kg-1in the other group.

AIM : To compare the onset , reduced dose of LA , amount of tourniquet pain , and prolonged post-deflation analgesia .

STUDY DESIGN :Comparitive study .

MATERIAL AND METHODS : Forty patients of ASA 1 and ASA 2 undergoing upper limb surgeries are allocated into two groups . Two intravenous (IV) cannulae were inserted, one (22G) in the hand of the side to be operated on and the other (20G) in the contra lateral hand for crystalloid infusion and drug administration. A double lumen tourniquet was positioned on the upper operative arm. The operative extremity was exsanguinated by elevation and wrapping it with a 10 cm Esmarch bandage. The proximal tourniquet was inflated to 100 mmHg more than systolic BP to a minimum of 250 mmHg and the Esmarch bandage was removed. Circulatory isolation of the operative arm was confirmed by inspection of the hand and by the absence of the radial pulse.
GROUP A : 2 % lignocaine 1ml/kg + dexmedetomidine (0.25 ug/kg)
GROUP B : 2% lignocaine 0.5 ml/kg + dexmedetomidine(0.5ug/kg)
In both the groups the solution is diluted with normal saline to a total of 40cc. Results : During both the intra-operative and early post-operative periods, there was a statistically significant reduction in the number of patients requiring rescueanalgesia.The quality of anaesthesia was better in group B though higher sedation score was noted postoperatively after the release of tourniquet. But there was no evidence of bradycardia or hypotension. There was no difference in the onset and regression of sensory and motor blockade. Conclusion : The addition of higher dose of dexmedetomidine led to use of lesser volume of lidocaine , longer postoperative analgesia and better tourniquet tolerance .