الفهرس 
Acknowledgement
Bier`S Block (Intravenous Regional AnaesthesiaOnly 14 pages are availabe for public view
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Abstract
• Intravenous Regional Anesthesia (IVRA) was first used by August Bier in 1908. This technique is easy to administer, reliable and cost-effective for short surgical procedures of the extremities performed on an ambulatory basis (ii) with success rate of approximately 95% - 100% [iii].
• Our study was randomized clinical trial, carried out in Assiut University Hospital, Faculty of Medicine, Assiut University.
• This study was designed to compare the anesthetic and analgesic efficacy of Dexmedetomidine and lidocaine versus lidocaine only during IVRA (Bier’s block) and to compare anesthetic and analgesic efficacy of different doses of dexmedetomidine when used as adjuvants to lidocaine during IVRA (Bier’s block).
• The eligible patients were randomly allocated into three equal groups using computer-based lists and then covered in closed envelopes.
group A: 20 patients received 3 mg/kg lidocaine 0.5%
group B: 20 patients received 3 mg/kg lidocaine 0.5% (maximum dose 200 mg ) + 0.5 ug/kg dexmedetomidine.
group C: 20 patients received 3 mg/kg lidocaine 0.5% (maximum dose 200 mg) + 0.25 ug/kg dexmedetomidine.
• The primary outcomes of the research were to measure:
The time to first analgesic request.
The onset and duration of sensory and motor blocks.
• The secondary outcomes were to measure:
• Mean arterial blood pressure, heart rate and SPO2 level.
• Pain due to the tourniquet.
• Levels of sedation.
• Any circumoral numbness and tingling, nausea and vomiting, skin rash, tinnitus, gastric discomfort and any other side effects.
• We found that, there were no significant differences between groups in the demographic and clinical characteristics regarding age, sex, weight, either in anesthesia time, surgical time, tourniquet time or operative procedure.
• There were moderate significance differences between different groups (P<0.005) with onset of sensory and motor block, sensory and motor recovery. With lowest mean value of onset of sensory and motor block in group B.
• There was a significance difference (P<0.005) in the quality of anesthesia between the three groups with group B which showing the highest value in the quality of anesthesia.
• There was a significance difference in the tourniquet pain and group B showing least number of patients experience tourniquet pain (only one patient).
• There was moderate significance difference (P<0.005) between different groups with highest mean value of time for first analgesic request group B.
• There was a significance difference (P<0.005) in total paracetamol consumption between the three studied groups with group B showing the lowest mean value in total paracetamol consumption.
• There were no significance difference in mean arterial pressure and heart rate between three groups.
• There was a significance difference (P<0.005) in visual analogue scale between three groups from (1h after tourniquet removal) until (12h after tourniquet removal). group B showed the lowest mean value in visual analogue scale.
• There was a significance difference (P<0.005) in Ramsey sedation scale between three groups from (15m after tourniquet removal) until (2h after tourniquet removal) with group B showing the highest mean value.
• There was a significance difference (P<0.005) in patient satisfaction score between three groups with group B showing the highest mean value (most satisfied patients).
Conclusion:
• In conclusion, using 0.5μg/kg low dose dexmedetomidine after intravenous regional anesthesia (IVRA) improves anesthesia quality and decreases the postoperative analgesic requirement of outpatients undergoing hand surgery than 0.25 μg/kg low dose dexmedetomidine without any severe side effects. It also showed that the mean starting time of sensory block was reduced following adding the dexamethasone to lidocaine. This is an essential element that can save time and help to provide a favorable anesthetic condition for patients. Besides, dexamethasone could elongate recovery from the sensory block and a decreased need for narcotics.
• These findings substantiate proving a more favorable anesthetic condition by adding dexamethasone to lidocaine. Therefore, adding dexamethasone to lidocaine in intravenous regional anesthesia is a promising method for improving the quality of anesthesia