Dexamethasone versus paracetamol in the augmentation of lidocaine in intravenous regional anesthesia in upper limb surgeries

Background In this study, we compare the effect of dexamethasone and paracetamol when added to intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, sensory and motor block onset times, sensory and motor recovery times, and tourniquet pain. Patients and methods Sixty adult patients undergoing elective surgical operations on the upper limb were randomly and blindly divided into three groups. All groups received IVRA lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml. Group 1 received lidocaine diluted with normal saline, group 2 received lidocaine and dexamethasone 8 mg admixture, and group 3 received lidocaine and 300 mg paracetamol. All patients were assessed as regards hemodynamics, O2 saturation, respiratory rate, intraoperative degree of analgesia, and onset of sensory anesthesia and motor block. After tourniquet deflation, time to recovery of sensory and motor block and the time to first analgesic requirement were assessed. Results The onset of sensory motor block occurred significantly earlier in group 2, followed by group 3 when compared with group 1. Patients in groups 2 and 3 tolerated tourniquet pain much better compared with group 1 patients. This led to prolonged time to first request for intraoperative analgesia and reduced the number of patients requiring fentanyl. As regards postoperative pain, patients in group 2 followed by group 3 patients tolerated the pain much better compared with group 1. This led to prolonged time to first request for analgesia. Conclusion Addition of dexamethasone to lidocaine in IVRA is superior to the addition of paracetamol.