Anesth Pain Med.  2024 Oct;19(4):310-319. 10.17085/apm.24105.

A comparative study of two different doses of dexmedetomedine as an adjuvant to lignocaine in infiltration block for tympanoplasty: a triple-blinded, prospective, randomized controlled trial

• Singh R
• Choudhary A
• Singh S
• Kumar H

• KMID: 2563573
• DOI: http://doi.org/10.17085/apm.24105

Abstract

Background
The ideal anesthetic drug choice for local infiltration anesthesia under monitored anesthesia care must provide analgesia and patients’ comfort along with a bloodless surgical field for patients. We hypothesized that dexemedetomidine can provide better visibility of the surgical field at a higher dose of 1 µg/kg than 0.5 µg/kg, along with providing sedation and analgesia. Methods: After institutional ethics committee clearance and written informed consent, this prospective, randomized, triple blind study was conducted on ninety patients, between 18- 65 years who were scheduled for tympanoplasty. The patients were randomly assigned to either the dexmedetomidine (DEX) 0.5 group or the DEX 1.0 group, and received 10 ml solution containing 2% lignocaine with 0.5 µg/kg dexmedetomidine, or the 1 µg/kg dexmedetomidine. The operative surgeon performed local infiltration using standardized 5-point infiltration technique around the auricle. The primary objective was to compare the intraoperative bleeding at the surgical site. The comparison of normally distributed variables was conducted using the Student’s t-test, whereas non-normally distributed variables was compared using the Mann-Whitney U test. The analysis of qualitative data was conducted using the chisquare/Fisher’s exact test. A P value less than 0.05 was considered statistically significant. Results: The overall bleeding score was significantly higher in the DEX 0.5 group (3.21 ± 0.727) than the DEX 1.0 group (1.43 ± 0.661) (P value < 0.001). The time to first analgesic requirement and surgeon satisfaction score were also significantly higher in the DEX 1.0 group. Conclusions: Combining dexmedetomidine at a dose of 1 µg/kg with 2% lignocaine for infiltration provided improved analgesia and improved the surgical field during tympanoplasty performed under monitored anesthesia care.

Keyword

Tympanoplasty; Dexmedetomidine; Monitored anesthesia care; Bloodless surgical field

Figure

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  Fig. 1. 5- Point infiltration technique. Point 1: insertion point- Anterior and superior to tragus with direction of needle as medial and lateral. Target nerve- Auriculotemporal nerve, Point 2: insertion point- Into everted tragus with direction of needle as superiorly and inferiorly. Target nerve- Auricular branch of Vagus nerve, Point 3: insertion point- Superiorly and inferiorly along the posterior sulcus with direction of needle as superiorly and inferiorly along the posterior sulcus. Field block, Point 4: insertion point- Posteriorly in auricular groove, at the level of posterior auricular ligament with direction of needle as superiorly and inferiorly along the posterior sulcus and medially. Field block, Point 5: insertion point- Posterior to lower lobe with direction of needle as superiorly along the posterior sulcus and medially. Target nerve- Greater Auricular nerve and Lesser Occipital nerves.

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  Fig. 2. CONSORT diagram showing the flow of participants through each stage of the randomized trial. CONSORT: Consolidated Standards for Reporting of Trials.

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  Fig. 3. Figure showing mean bleeding score with Standard deviation of the two groups. DEX 0.5 group: patients received 10 ml of 2% lignocaine with 0.5 µg/kg dexmedetomidine (n = 45), DEX 1.0 group: patients received 10 ml of 2% lignocaine with 1 µg/kg dexmedetomidine (n = 45). DEX: dexmedetomidine.

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  Fig. 4. Figure showing mean systolic blood pressure of the two groups with standard deviation over timeline. SBP: systolic blood pressure, DEX 0.5 group: patients received 10 ml of 2% lignocaine with 0.5 µg/kg dexmedetomidine (n = 45), DEX 1.0 group: patients received 10 ml of 2% lignocaine with 1 µg/kg dexmedetomidine (n = 45). SBP: systolic blood pressure, DEX: dexmedetomidine.

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