الفهرس 
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Abstract
This study was carried out in El-Minia University hospital in the period from January 2011 to January 2012 on sixty patients ASA physical status I or II , aged 18-60 years and undergoing elective minor of moderate surgical operations on the hand , wrist or forearm , with expected surgical times less than ninety minutes.
These patients were divided into three groups each included twenty patients with a double blinded design ; group (1)(control) received IVRA using upper arm tourniquet with 3 mg/kg lidocaine 2% (maximum 200 mg) diluted with normal saline to a total of 40 mL , group (2)(dex) received IVRA using upper arm tourniquet with 3 mg/kg lidocaine 2% (maximum 200 mg) + 8 mg dexamethazone diluted with normal saline to a total of 40 mL , group (3)(par) received IVRA using upper arm tourniquet with 3 mg/kg lidocaine 2% (maximum 200 mg) + 300mg paracetamol diluted with normal saline to a total of 40 mL .
We aimed in this study to compare the effect of dexamethazone or paracetamol on intraoperative and postoperative analgesia , sensory and motor block onset times , sensory and motor recovery times and tourniquet pain when added to lidocaine .
All patients were assessed as regard to the hemodynamics (including mean arterial blood pressure , heart rate , O2 saturation and respiratory rate) . Preoperatively and then at 5,10,20,40 min till the end of the surgery , then at 5, 10,20,40,60 min post tourniquet release , and then every hour till 4 hours postoperatively .
Also the intraoperative degree of analgesia was assessed at 5,10,20,40 min till the end of the surgery , then at 10,30,60,90,120,180 min then every three hours for twenty- four hour.
Onset of sensory anesthesia (by Pin Pick) and motor block (asking the patient to flex and extend the wrist and fingers ) were evaluated .
After tourniquet deflation , times to recovery of sensory and motor block and the time to first analgesic requirement were assessed .
There was insignificant statistical difference between the three groups as regards the demographic data ( age, sex and weight ) and duration and type of surgery.
There was significant statistical difference as regards the heart rate between the groups at 10 min with (P= 0.001) , mean arterial blood pressure with (P=0.001) and respiratory rate with (P=0.001) .But as regards O2 saturation there was insignificant statistical difference between the groups .
The onset of sensory anesthesia occurred significantly earlier in group(2)(dex)(4.2 ±1.01min) then group(3)(par)(5.1 ± 0.9 min) when compared to group(1)(control) (6.7± 1.5min).The addition of dexamethazone to lidocaine hastened the onset of sensory loss more than paracetamol .
Also our results showed that dexamethazone in group(2)(dex)(6.8± 1.05 min) then paracetamol in group (3)(par)(7.1 ± 1.5 min) showed a significant reduction in the onset of loss of motor power when compared to lidocaine alone in group(1)(control)(9.7 ± 1.3 min) in IVRA.
Patients in group(2) (dex) then group(3)(par) tolerated tourniquet pain much better than in group(1) (control) , this led to long the time for first request of intraoperative analgesia and reduced the number of patients need fentanyl .
As regard return of sensation and motor power they were significantly prolonged in group(2)(dex)(14.3 ± 1.5 min) then group(3) (par)(11.9± 1.9 min) when compared to group(1)(control)(8.9±1.1 min).
As regard return of motor power significantly prolonged in group(2)(dex) (18.8± 1.1 min) then group(3) (par) (15.6 ± 1.1 min)when compared to group(1) (control) (12.6 ± 2.3 min).
As regard postoperative pain , patients in group(2) (dex) , then group(3)(par) tolerated pain much better than group(1)(control) , this led to long the time for first request of analgesia .
In group(2)(dex) the first time to analgesic request was (126.7 ± 18.2 min) , in group(3) (par) the first time to analgesic request was (99.6 ± 10.03 min) whereas in group(1)(control) it was (65.9 ± 39.4 min) .
In our study there was two patients in group(1) (control), one patient in group(2) (dex) and two patients in group(3) (par) suffered from nausea (disappeared spontaneously .