Evaluation the effect of dexmedetomidine or tramadol when added to lidocaine for intravenous regional anaesthesia

Dexmedetomidine is approximately 8 time more selective toward the alpha 2-adrenoceptors than clonidine. It decreases anaesthetic requirements by up to 90% and induces/analgesia in patients. Tramadol, a centrally acting analgesic, might have local anaesthetic properties as do some opioid drugs. We designed this study to evaluate the adjuvant effect of dexmedetomidine or tramadol when added to local anaesthetc in IV regional anaesthesia. Forty five patients undergoing hand or forearm surgery were randomly assigned to 3 groups to receive IVRA. Each group 15 patients, lidocaine 0.5% group [group L], a mixture of 0.5% lidocaine and 0.25% tramadol [group TL] or mixture of 0.5% lidocaine and 0.5 ug/kg dexmedetomidine. We investigated onset and duration of sensory and motor blocks, the quality of the anaesthesia, intraoperative - postoperative heamodynamic, pain and sedation. We found that the addition of dexmedetomidine or tramadol modify the action of local anaesthetic, providing a shorter onset time of sensory block and less tourniquet pain in IVRA but dexmedetomidine more better because faster and less incidence of side effect

Advantages of addition of intrathecal morphine compared with addition of small dose intrathecal sufentanil in cesarean section

Spinal anaesthesia is widely used for cesarean delivery. Its quality can be improved by intrathecal [IT] addition of opioids to local anaesthetics. For obstetric analgesia, however spinal morphine alone was relatively ineffective and plagued with side effect. Spinal anaesthesia with bupivacaine combined with sufentanil has been widely used for cesarean delivery. However, the main site of action [spinal VS central] of IT sufentanil is controversial. The aim of this study was to test the responsiveness of IT sufentanil and its relative efficacy and incidence of side effect compared with intrathecal morphine after cesarean deliveries. The study done on 90 healthy ASA I or II physical status. Patients were randomly allocated to three groups. Each group of 30 patients. They received either hyperbaric bupivacaine alone [group 1] or with morphine 0.2 mg [group 2] or sufentanil 2.5 ug [group 3]. We found that the addition of IT small dose of opioid produced a significant longer duration, better quality and excellent post operative analgesia. Sufentanil was found to be more better than morphine because of less adverse effect