Dexmedetomidine Combined with Femoral Nerve Block Provides Effective Analgesia Similar to Femoral Nerve Combined with Sciatic Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study

Abstract

Background: Total knee arthroplasty (TKA) is a severe traumatic procedure, and femoral nerve block (FNB) combined with a sciatic nerve block (SNB) is widely used in TKA. However, injury of the sciatic nerve is clinically reported. Dexmedetomidine (DEX) could reduce stress and inflammation, as well as improve pain in TKA. This study aims to observe the analgesic impact of DEX combined with FNB in TKA. Methods: Eighty-eight patients undergoing TKA were included and randomly divided into two groups: DF group (FNB combined with DEX 0.6μg/kg before surgery, followed by DEX 0.2-0.4μg/kg/h until articular closure) and SF group (FNB combined with SNB). Each nerve was blocked with 0.375% ropivacaine 20mL, and all patients received general anesthesia routinely. The primary endpoint was the pain visual analog scale (VAS) score during activities at postoperative 24 hours. Results: There was no statistical difference in the pain VAS scores at any time point. The mean duration of analgesia for patients with rescue analgesic requests was comparable between the two groups: 25.4 ± 6.3 hours in the DF group vs 24.8 ± 6.4 hours in the SF group (two-sample t-test, p=0.738). The total dose of sufentanil was similar between groups (P=0.355). The maintenance dose of propofol and dose of rescue analgesics were comparable (all P>0.05). There were no statistical differences in the incidence of adverse events. However, the time to extubate in the DF group was significantly longer than those in the SF group (P<0.001). Conclusion: DEX combined with FNB could provide effective analgesia similar to SNB combined with FNB in TKA. Clinical Trial Registration: The trial was registered at the Chinese Clinical Trial Registry on November 17, 2019 (identifier: ChiCTR1900027552).

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

“…Xiao et al 72 compared the difference between femoral and sciatic nerve blocks. The results indicated that the analgesic effect of dexmedetomidine combined with femoral nerve block in TKA was similar to that of femoral-sciatic nerve block.…”

Dexmedetomidine sebagai Adjuvan Anestesi dalam Peripheral Nerve Block

“…Namun, banyak studi menetapkan bahwa dosis aman maksimum dexmedetomidine adalah 2 μg/kg. Namun, menurut penelitian terbaru oleh (Xiao et al, 2022), dosis 1 μg/kg dexmedetomidine memberikan keseimbangan yang otimal antara analgesia pascaoperatif yang memadai dan efek samping dari blok saraf perifer.\ Penelitian sebelumnya menunjukkan bahwa dosis dexmedetomidine berpengaruh pada efeknya di sekitar area yang diolah, dengan dosis 100 μg dexmedetomidine menunjukkan peningkatan waktu blok yang signifikan. Meskipun banyak studi menetapkan dosis aman maksimum dexmedetomidine adalah 2 μg/kg, penelitian terbaru menyarankan bahwa dosis 1 μg/kg dexmedetomidine memberikan keseimbangan optimal antara analgesia postoperatif dan efek samping blok saraf perifer.…”

“…Sedangkan efek perifer dexmedetomidine bergantung pada dosis, dan 100 μg dexmedetomidine memiliki keunggulan lebih dalam memperpanjang waktu blok. Banyak penelitian menetapkan bahwa dosis maksimal aman dexmedetomidine adalah 2 μg/kg (Vorobeichik et al, 2017;Xiao et al, 2022). Oleh karena itu, dosis dexmedetomidine 1 μg/kg memberikan keseimbangan optimal antara analgesia postoperatif yang memadai dan efek samping blok saraf perifer (Xiao et al, 2022).…”

Comparing Efficacy of Analgesic Modalities in Patients Undergoing Total Knee Arthroplasty [Letter]

“…In a noninferiority randomized controlled trial with 88 patients undergoing elective total knee arthroplasty (TKA), Xiao et al 1 showed that dexmedetomidine (Dex) combined with femoral nerve block (FNB) provided similar analgesic efficacy to FNB combined with sciatic nerve block (SNB). Other than the limitations described in the discussion, however, we noted other issues in the design and results of this study that deserve further discussion and clarification.…”