Median Effective Dose of Dexmedetomidine in Elective Upper Limb Lidocaine Intravenous Regional Anesthesia
Condition: Intravenous Drug Usage
Study type: Interventional
Phase: Phase 4

Summary: 
      Auxiliary drugs augment the effect of local anesthetic in intravenous regional anesthesia
      (IVRA). The purpose of our study was to estimate the median effective dose (ED50) of
      Dexmedetomidine in elective upper limb Lidocaine 0.5% IVRA.
    

Detailed description: 
      Since its innovation in 1908 by Dr August Bier of Germany, Intravenous regional anesthesia
      (IVRA) has stood the test of time as simple, safe and effective technique of regional
      anesthesia. 1 The technique entails insertion of intravenous catheter into a surgical limb
      before isolating it from the general circulation by tourniquet then inject local anesthetic
      (LA) into this isolated limb. 2 IVRA block is preferably used with short surgical procedures
      or maneuvers of the upper or lower extremity. Nevertheless, the technique has gained
      popularity for procedures of the upper extremity because of tourniquet issues like tourniquet
      pain, and other safety concerns that arise more often with lower extremity IVRA, essentially
      leakage of the of LA.3 Unfortunately, using LA solely for IVRA has not achieved optimum
      intraoperative analgesia or overcome the frequently reported tourniquet pain.4 A long list of
      adjuvants, to mention few: morphine, muscle relaxant and clonidine, have been used to augment
      LA action and ameliorate tourniquet pain. 5 Dexmedetomidine (DEX) a potent α 2 agonist that
      have unique analgesic, anxiolytic and sedative profile has been called upon as attractive
      adjunct in general as well as regional anesthesia with enticing results. Several studies have
      pursued DEX median effective dose (ED50) in different settings e.g., co induction agent with
      Propofol, in laryngeal muscle insertion and with local anesthetic to enhance the quality of
      spinal anesthesia. 6 However, DEX effective median dose ED50 with IVRA for upper limb has not
      been investigated elsewhere, so far. The up and down sequential method of Dixon and Mood is a
      common sequential design method used in anesthesia research to detect the ED50. It is a
      sequence of experiments performed under the assumption that "satisfactory response" is
      followed by decrease in test dose for the next patient in the series, and "non- satisfactory
      response" is followed by increase in test dose for the next patient in the series. 7 The
      purpose of this study is to estimate the median effective dose of Dexmedetomidine (DEX) with
      Lidocaine 0.5% IVRA in upper limb elective surgeries, using modified Dixon's up and down
      method.
    

Intervention name(s): Dexmedetomidine
Intervention type(s): Drug
Intervention description(s): Dexmedetomidine (DEX) a potent α 2 agonist that have unique analgesic, anxiolytic and sedative profile has been called upon as attractive adjunct in general as well as regional anesthesia with enticing results. Several studies have pursued DEX median effective dose (ED50) in different settings e.g., co induction agent with Propofol, in laryngeal muscle insertion and with local anesthetic to enhance the quality of spinal anesthesia
Other intervention name(s): dixon's sequential method
Intervention MeSH terms: Dexmedetomidine
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment