Effect of adding dexamethasone to lidocaine on the quality of intravenous regional anesthesia for upper extremity orthopedic operations: A randomized clinical trial

BACKGROUND: Intravenous regional anesthesia (IVRA) is an ideal technique for short surgery on the distal extremities. Different additives have been used to improve lidocaine’s block quality. OBJECTIVE: The aim of this study was to determine the effect of adding dexamethasone to lidocaine on improving the quality of IVRA. METHODS: This study is a prospective, double-blind randomized study which was done on patients with upper extremity injuries of the distal elbow in Shahid Mohammadi Hospital, Bandar Abbas from October 2014 to December 2015. A total of 110 patients aged 15 to 65 years, with ASA class I and II, with orthopedic injuries distal to the elbow, were randomly divided into two groups. The control group (L) and the intervention group (L+D) received a 40-ml solution of 3 mg/kg lidocaine, and 3 mg/kg lidocaine + 8 mg of dexamethasone respectively. The two groups were compared in terms of onset and recovery time of sensory block in each of the dermatome nerves classified as radial, ulnar, and median, vital signs, patient satisfaction, intraoperative opioid consumption, and request for the first postoperative opioid. RESULTS: There was no significant difference between the two groups in terms of demographic characteristics. Mean arterial blood pressure was higher in the L + D group (100.39±14.6 mmHg) in comparison to the L group (90.50±11 mmHg) (p=0.002). Need for opioid was reported in 20 (35.7%) patients in the L + D group in comparison to 17 (31.5%) in the L group (p=0.639). The average intraoperative dose of fentanyl was 95±32.04 mcg and 88.44±18.77 mg in L + D and L groups respectively and there was no significant difference between the two groups in this respect (p=0.479). In addition, the average dose of pethidine administered in the recovery room for L + D group (19.34±15.22) mg was significantly higher than in the L group (9.44±12.26 mg) (p=0.001). CONCLUSIONS: Adding 8 mg dexamethasone to lidocaine has no effect on IVRA solution in upper extremity orthopedic operations and also increases postoperative opioid consumption. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016052928158N1. FUNDING: The authors received financial support from Hormozgan University of Medical Sciences.