Comparison of intrathecal versus intra-articular dexmedetomidine as an adjuvant to bupivacaine on postoperative pain following knee arthroscopy: a randomized clinical trial

Abstract

BackgroundPostoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery.MethodsNinety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels.ResultsDexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group.ConclusionsBoth intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.

Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

“…21,22 Opioid- attributed to the relatively small dose used and the poorly vascular articular surface. 5 Ismail et al 28 recruited 90 patients undergoing unilateral elective knee arthroscopy and concluded that IA was superior to intrathecally administered dexmedetomidine due to prolonged analgesia (413 ± 34 min) in the IA group compared with 359 ± 30 and 224 ± 36 min in the intrathecal and control groups respectively, in addition to 24 h less analgesic consumption than the other groups.…”

“…Al-Metwalli et al 5 concluded that IA dexmedetomidine alone provided around 312 min mean time of postoperative analgesia after knee arthroscopy. No systemic side effects were observed in any of the study groups.…”

“…Based on the results of previous study 5 at least 29 patients in each group were needed to detect a significant prolongation of 90 min at α error of 0.05 and study power of 80%.…”

“…1 Many studies have used different IA agents such as opioids, ketamine, NSAIDS and α 2 adrenergic agonists for pain management after knee surgeries. 5,6 Dexmedetomidine is a potent and highly selective α 2 adrenoreceptor agonist that binds the α 2 -receptors up to eight times more avidly than clonidine, with well-recognised sedative-hypnotic, anxiolytic, analgesic, anaesthetic and sympatholytic effects. 7 Intravenous and intraarticular dexmedetomidine have been used in several studies to enhance postoperative analgesia after knee arthroscopy and have demonstrated an increased time to first analgesic request and a decreased need for postoperative analgesia.…”

“…7 Intravenous and intraarticular dexmedetomidine have been used in several studies to enhance postoperative analgesia after knee arthroscopy and have demonstrated an increased time to first analgesic request and a decreased need for postoperative analgesia. 5,6 IA dexmedetomidine has been used before in doses of 50 μg and 80 μg. So, we hypothesised that IA dexmedetomidine at 100 μg would result in satisfactory prolongation of analgesic duration without increased adverse effects.…”