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

Abstract

Background: Optimal relief of pain after knee arthroscopy is essential for early rehabilitation and mobilisation and to minimise postoperative morbidity. This study's aim was to assess dexmedetomidine as an additive to intra-articular (IA) bupivacaine in terms of analgesic duration and postoperative rescue analgesic consumption following arthroscopic knee surgery. Methods: A total of 70 patients, ASA physical status I and II, undergoing knee arthroscopy under general anaesthesia were enrolled in this double-blinded randomised controlled study, after Pan African Clinical Trial Registry (PACTR201507001048242) approval was obtained. Patients were randomly assigned into two groups; the bupivacaine group (B) received IA 19 ml bupivacaine 0.5% + 1 ml normal saline, bupivacaine dexmedetomidine group (BD) received IA injection of 19 ml bupivacaine 0.5% + dexmedetomidine 100 μg (1 ml). Postoperative visual analogue pain score (VAS), duration of analgesia and postoperative analgesic requirement were assessed. Results: VAS scores at rest and on mobilisation were significantly lower in the BD group at 4 h, 6 h and 8 h postoperatively in comparison with group B (p < 0.05). VAS scores were comparable between studied groups during the first 2 h, and at 12 h and 24 h postoperatively. Duration of analgesia was significantly longer in group BD (458.9 ± 93.5 min) than in the B group (229.1 ± 83.7 min) (p < 0.05). Postoperative analgesic consumption was lowered in the BD group compared with the B group (p < 0.05). Conclusions: Adding dexmedetomidine to IA bupivacaine after knee arthroscopy prolongs analgesic duration and decreases postoperative analgesic requirement.

How does intraarticular dexmedetomidine injection effect articular cartilage and synovium? An animal study

“…Shaimaa FM and colleagues assessed the effects of dexmedetomidine as an adjuvant to bupivacaine on pain scores and analgesic consumption [2]. In that double-blind randomized controlled study, dexmedetomidine as an adjunct to local anesthetic was found to prolong the analgesic duration and decrease the postoperative analgesic requirement [2].…”

“…Shaimaa FM and colleagues assessed the effects of dexmedetomidine as an adjuvant to bupivacaine on pain scores and analgesic consumption [2]. In that double-blind randomized controlled study, dexmedetomidine as an adjunct to local anesthetic was found to prolong the analgesic duration and decrease the postoperative analgesic requirement [2]. The researchers underlined the safety concerns about local adverse effects on chondrocytes and concluded that these effects should be clarified before making any recommendation about the drug [9].…”

“…In another study by Panigrahi R and colleagues, the pain relief effect of intraarticular dexmedetomidine (2 μg/kg) as an adjuvant to ropivacaine in arthroscopic surgeries proved to have superior analgesic effect in arthroscopic knee procedures and decreased the need for postoperative analgesics, without any major adverse effect, apart from the chondrocyte functions being evaluated [ 27 ]. Shaimaa FM and colleagues assessed the effects of dexmedetomidine as an adjuvant to bupivacaine on pain scores and analgesic consumption [ 2 ]. In that double-blind randomized controlled study, dexmedetomidine as an adjunct to local anesthetic was found to prolong the analgesic duration and decrease the postoperative analgesic requirement [ 2 ].…”

“…Knee arthroscopy is a commonly performed procedure for both the diagnosis and treatment of internal structures of the knee. Arthroscopic procedures, especially knee arthroscopy, are associated with serious postoperative pain caused by irritation of the free nerve endings of the synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection [1][2][3]. Adequate analgesia is the key to patient satisfaction and low morbidities [4].…”

A Comparative Evaluation of Intra-articular Bupivacaine vs Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgeries

“…The sample size was determined by taking the total consumption of rescue analgesia in milligrams in 24 hours with reference to the study by Mostafa et al [18]. The reference study was done with 42 patients.…”