Comparison of Lidocaine Alone Versus Lidocaine with Dexmedetomidine for Intravenous Regional Anesthesia

Background: Intravenous regional anesthesia (IVRA) is an efficient method of short limb surgery but often provides limited pain relief in the postoperative period. Dexmedetomidine is an α2-adrenergic agonist that can potentially improve local anesthetic effects, but there is limited evidence in Pakistan because of its previous unavailability. This study aimed to compare lidocaine alone and lidocaine combined with dexmedetomidine IVRA in below-elbow surgery. Methods: This randomized control study was conducted at Fatima Memorial Hospital, Lahore, from September 3, 2024, to March 2, 2025. 90 ASA I-II patients, aged 18-60 years, who were undergoing elective upper limb surgery, were randomly assigned to two groups. Group A received regional anesthesia with 40ml of lignocaine 0.5%, while Group B received (Bier's Block) the same lignocaine with 0.5µg/kg dexmedetomidine. Tourniquet pain after 2 hours and anesthesia duration were noted. Data were analyzed using SPSS v25.0 with a p-value ≤0.05 as statistically significant. Results: The Lidocaine plus Dexmedetomidine group showed significantly lower mean pain scores (1.49 ± 0.506) compared to the Lidocaine alone group (2.78 ± 0.704) with a p-value of 0.001. The duration of analgesia was significantly extended in the combination group (190.82 ± 33.71 minutes) when compared to the Lidocaine-alone group (145.73 ± 13.23 minutes), also with a p-value of 0.001. Conclusion: The combination of dexmedetomidine with lidocaine during IVRA is highly effective in enhancing postoperative analgesia and pain reduction that may lead to an efficient intervention to perform perioperative pain management during upper limb surgery.