title: The effect of dexmedetomidine added to preemptive (2% lignocaine with adrenaline) infiltration on intraoperative hemodynamics and postoperative pain after ambulatory maxillofacial surgeries under general anesthesia.
abstract: BACKGROUND
  Lignocaine + adrenaline; a local anesthetic agent; frequently used for perilesional infiltration, maintains the stable hemodynamics and decreases the postoperative pain after maxillofacial surgery. α2 agonists have peripheral analgesic effects. This prospective study was to evaluate the effectiveness of perilesional dexmedetomidine administered preincisionally in addition to conventional lignocaine adrenaline combinations for reconstructive maxillofacial surgery in an ambulatory care setting.
  
  
  METHODS
  76, American Society of Anesthesiologists I-II patients scheduled for unilateral traumatic maxillofacial surgeries were randomly allocated into group DL (n = 38) receiving 15 cc of 2% lignocaine + adrenaline (1:200,000) mixed with 1 μg/kg dexmedetomidine and group PL receiving 15 cc of 2% lignocaine + adrenaline with normal saline (placebo) via local wound infiltration 5 min prior to skin incision. Perioperative hemodynamics, time to first analgesic use, total analgesic need, bleeding, and side effects were recorded for each patient.
  
  
  RESULTS
  Dosage of supplemental propofol; total perioperative, postoperative, and postanesthesia care unit (PACU) fentanyl consumption was significantly lower (P = 0.0001, P= 0.0001, P= 0.0001, P= 0.004, respectively) in dexmedetomine treated group than placebo. Rescue analgesic requirement was significantly earlier in group PL than group DL. Group DL patients suffered from significantly less (P = 0.02) bleeding and surgeon's satisfaction score was also high in this group. Discharge from PACU was significantly earlier in group DL. Intraoperative hemodynamic parameters were significantly lower in group DL (P < 0.05) without any appreciable side effects.
  
  
  CONCLUSIONS
  Thus, prior dexmedetomidine local infiltration at the site of maxillofacial trauma has significantly reduced bleeding from wound site; perioperative fentanyl, propofol consumption, and subsequently ensured earlier discharge from PACU, better surgeon's satisfaction score with better hemodynamic control and lesser side effects.
authors.affiliation: Department of Oral and Maxillofacial Surgery, R. Ahmed Dental College, Kolkata, West Bengal, India.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mandal
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Anjan
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Subinay
authors.initials: S
authors.lastname: Chhaule
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Partha Sarathi
authors.initials: PS
authors.lastname: Halder
authors.affiliation: Department of Gynecology and Obstetrics, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Joydip
authors.initials: J
authors.lastname: Paul
authors.affiliation: Department of Anaesthesiology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: RoyBasunia
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Surajit
authors.initials: S
authors.lastname: Chattopadhyay
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Subrata Kumar
authors.initials: SK
authors.lastname: Mandal
keywords: Dexmedetomidine; lignocaine with adrenaline; perilesional infiltration (infiltration of drug 1 cm outside the planned line of incision); postanesthesia care unit; reconstructive maxillofacial surgery