A dose reduction study of local anesthetic with addition of dexmedetomidine on postoperative epidural analgesia after total knee arthroplasty

Abstract

Background: Epidural analgesia is still the preferred method of postoperative analgesia for total knee arthroplasty in many countries. Dexmedetomidine is a new alpha-2 agonist which had many beneficial effects when administered epidurally. The aim of study was to provide effective postoperative analgesia with hemodynamic stability through reduction of the amount of epidural local anesthetic by adding dexmedetomidine. Methods: 75 patients, 50-70 years old, ASA physical status I-III undergoing total knee arthroplasty were randomly divided into three equal groups, group I received 0.125% bupivacaine 5 ml/h for postoperative analgesia, group II received 4 ml of a mixture of bupivacaine 0.125% and dexmedetomidine 0.2 lg/kg/h and group III received 3 ml of a mixture of bupivacaine 0.125% and dexmedetomidine 0.2 lg/kg/h. Postoperative pain were scored by visual analog scale (VAS), sedation score, postoperative nalbuphine consumption and hemodynamic parameters were recorded every 4 h for 48 h postoperatively. Results: The demographic data were comparable in all groups. VAS (visual analog scale) of pain showed a significant reduction between the two groups II, III and group I with insignificant difference between groups II and III at both rest and movement. The mean of nalbuphine consumption during the study period was significantly reduced in group II, III than in group I with insignificant difference between groups II and III. Sedation scores were significantly higher in groups II and III compared to group I. Heart rate was more reduced in groups II and III than in group I with insignificant difference between the groups. The mean arterial blood pressure was significantly reduced in group I than groups II and III from hour 8 till the end of the study. Conclusion: Dexmedetomidine is an effective adjuvant to epidural bupivacaine for postoperative analgesia after total knee arthroplasty through reducing the amount of local anesthetic.

Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

“…The initial literature search identi ed 143 articles, of which 135 were excluded because they failed to meet the eligibility criteria. A total of 7 RCTs involving 546 participants were ultimately included in this meta-analysis (8)(9)(10)(11)(12)(13)(14). The PRISMA ow diagram is presented in Fig.…”

Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

“…The initial literature search identi ed 143 articles, of which 135 were excluded because they failed to meet the eligibility criteria or were duplicates. A total of 7 RCTs involving 546 participants were nally included in this meta-analysis (8)(9)(10)(11)(12)(13)(14). The PRISMA ow diagram is presented in Fig 1. The evidence quality and risk assessment were evaluated according to the Cochrane Collaboration's tool for assessing risk of bias.…”

“…The PRISMA ow diagram is presented in Fig 1. The evidence quality and risk assessment were evaluated according to the Cochrane Collaboration's tool for assessing risk of bias. Four RCTs (8,10,12,14) were considered unclear risk of bias because the original protocols were not available. One RCT (11)was considered unclear risk of bias for no descriptions concerning allocation concealment.…”

“…Total opioids consumption was recorded in 4 studies (8,9,11,12) containing patients. Pooled data indicated that there were signi cant differences between these two groups (SMD = -0.63[-0.86 to -0.40], P<0.01, I 2 = 0%, Fig 5).…”

“…Sedation degree for postoperative 24 and 48 hours was recorded in 2 studies (8,14) containing 165 patients. Signi cant differences were found between the Dex.…”