title: Role of addition of Dexamethasone and Ketorolac to lignocaine intravenous regional anesthesia (Bier's Block) to improve tourniquet tolerance and post-operative analgesia in hand and forearm surgery.
abstract: OBJECTIVE
  To compare tourniquet tolerance and postoperative analgesia using lignocaine intravenous regional analgesia alone or with addition of dexamethasone and ketorolac.
  
  
  METHODS
  The randomised, prospective study was conducted at Mayo Hospital, Lahore, from June 2013 to June 2014. Patients were divided into three groups: group I received lignocaine; group II received lignocaine and 30mg ketorolac; and group III received lignocaine, 30mg ketorolac and 08mg dexamethasone for intravenous regional anaesthesia. A total of 40ml solution was made by diluting it with normal saline. Motor and sensory block and recovery times were noted. Visual analogue scale was used to assess the severity of surgical and tourniquet pain, and total number of analgesic tablets taken in the first 24 hours after surgery were also recorded.
  
  
  RESULTS
  The 180 patients in the study were divided into three equal groups of 60(33.3%) each, with each group having 30(50%) male and 30(50%) female subjects. In all the three groups, the sensory and motor onset and recovery time was the same (P> 0.05). Lower pain scores were reported in groups II and III compared to group I (p<0.001). Patients of group II and III also required fewer analgesic tablets postoperatively and had longer postop time during which no analgesia was given compared to group I (p<0.05).
  
  
  CONCLUSIONS
  Bier block using lignocaine, dexamethasone and ketorolac provides better tourniquet tolerance in patients undergoing hand and forearm surgeries when compared to use of lignocaine alone and lignocaine and ketorolac.
authors.affiliation: Department of Orthopedic Surgery and Traumatology Unit-1, Mayo Hospital Lahore, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Akram
authors.affiliation: Department of Orthopedic Surgery and Traumatology Unit-1, Mayo Hospital Lahore, Pakistan.
authors.forename: Faheem Mubashir
authors.initials: FM
authors.lastname: Farooqi
authors.affiliation: Department of Orthopedic Surgery and Traumatology Unit-1, Mayo Hospital Lahore, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irshad
authors.affiliation: Department of Orthopedic Surgery and Traumatology Unit-1, Mayo Hospital Lahore, Pakistan.
authors.forename: Syed
authors.initials: S
authors.lastname: Faraz Ul Hassan
authors.affiliation: Department of Orthopedic Surgery and Traumatology Unit-1, Mayo Hospital Lahore, Pakistan.
authors.forename: Syed Muhammad
authors.initials: SM
authors.lastname: Awais
keywords: Bier\'s block, Ketorolac, Dexamethasone, Lignocaine.