الفهرس 
Acknowledgments
PainOnly 14 pages are availabe for public view
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Abstract
Intravenous regional anesthesia (IVRA) is one of the safest and easiest techniques of regional anesthesia for surgery of short procedures on the upper limbs. In 2012, the American Society of Anesthesiologists (ASA) released an update to its Practice Guidelines for Acute Pain Management in the Perioperative Setting. In this report, the ASA strongly recommends use of a multimodal approach to pain management whenever possible. Intravenous regional anesthesia (IVRA) is a method of producing analgesia in distal part of a limb by intravenous injection of local anesthetic agent into the vein of the same limb while circulation in the limb is occluded by application of tourniquet. It is a safe and reliable technique. Also, the need for specific anatomical knowledge is not required. Lidocaine inhibits action potential propagation within neuronal tissue by binding to receptors in Na+ channels located on the nerve cell membrane. Lidocaine IVRA is safe and effective and is associated with a rapid onset of anesthesia after injection and termination of analgesia once the tourniquet is deflated. It aimed to compare the independent effect of low dose verapamil and Dexamethasone and their combined effect on duration of post-operative analgesia in case of IVRA in upper limbAccording to sample size calculator, the 90 patients of the present study were randomly allocated into three equal groups. group (I) received lidocaine 2% 3mg/kg plus 8mg dexamethasone for bier block. group (II) received lidocaine 2% 3mg/kg with plus 5mg verapamil for bier block. group (III) received lidocaine 2% 3mg/kg plus 4mg dexamethasone plus verapamil 2.5mg for bier block. Primary outcome: Is the time to first postoperative rescue analgesia Secondary outcomes: Included postoperative VAS, sensory and motor blockade, tourniquet pain, hemodynamic variables, satisfaction score and any side effects. In this study, The time to first postoperative rescue analgesia was prolonged in group (II) and group (III) compared to group (I) postoperatively. Satisfaction score was significantly higher in group (II) and group (III) than in group (I) postoperatively. There was a significant decrease in the mean heart rate and the mean arterial blood pressure in group(II) compared to group (III)and group (I) postoperatively. VAS was lower in group (II) and group (III) compared to group (I) postoperatively. No significant changes were noted in the SpO2 between the studied groups throughout the study period. There were also comparable differences between the 3groups as regards the side effects of IVRA . The occurrence of bradycardia, hypotension, nausea, vomiting, and drowsiness were significant in group (II) compared to groups (I) and (III). Conclusion Addition of verapamil 2.5 mg to lidocaine plus dexamethasone (4mg) for IVRA provided more effective anesthesia, prolonged postoperative analgesia and decreased postoperative analgesic consumption than with dexamethasone (8mg) to lidocaine or verapamil (5mg) to lidocaine. The postoperative undesirable side effects of verapamil 5 mg e.g. bradycardia, hypotension, nausea, vomiting, drowsiness and paresthesia were significantly common. Adding verapamil 2.5 mg to 40 ml of 0.5% Lidocaine plus dexamethasone (4 mg) for Bier’s block was effective and safe adjuvants for acute pain after surgery.