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ESRA19-0417 The impact of the addition dexmedetomidine to local anaesthetic for intravenous regional anaesthesia: a systematic review
  1. I Karmaniolou1,
  2. P Surda2,
  3. C Staikou3 and
  4. MP Sebastian4
  1. 1Consultant in Anaesthesia, Anaesthesia, London, UK
  2. 2Guy’s and St Thomas’ NHS Foundation Trust, Ent, London, UK
  3. 3Aretaieio University Hospital, Anaesthesia, Athens, Greece
  4. 4Royal National Orthopaedic Hospital, Anaesthesia, Middlesex, UK


Background and aims Intravenous regional anaesthesia (IVRA) is a simple and reliable method of providing anaesthesia for minor surgical procedures of the extremities [1,2]. Short duration is a major limitation. Various adjuvants have been used in an effort to overcome this. Dexmedetomidine, a selective alpha-2 receptor agonist has been extensively studied in recent years with variable results [3]. Our aim is to determine the duration of analgesia, onset time of sensory and motor block and incidence of tourniquet pain.

Methods We conducted systematic searches for randomised controlled trials (RCTs) for articles in English published between January 1990 and December 2018. We used a combination of the MeSH and text search terms ‘dexmedetomidine’ and/or ‘adjuvant’, ‘IVRA’ and ‘Bier block’ in all possible combinations. We used the Cochrane ‘Risk of bias’ tool in RevMan 5 to evaluate the studies included.

Results Of the 115 citations identified by the search, 7 satisfied the selection criteria and were included in this review. In total 318 patients were randomised to dexmedetomidine and 159 to the control group. Intraoperative analgesia duration was significantly longer in the dexmedetomidine group (MD 11.08 minutes; 95% CI 5.42, 16.75; P<0.0001) (figure 1). Incidence of tourniquet pain was lower with dexmedetomidine. Sensory block onset time was shorter in the dexmedetomidine group (MD -2.10 minutes; 95% CI -3.345, -0.86; P = 0.00009) (figure 2). No difference in motor block onset between groups was found (figure 3).

Conclusions Dexmedetomidine enhances the onset of sensory block and increases the duration of the block with no effect on the onset of motor block.

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