Ultrasound-Guided Continuous Femoral Nerve Block with Dexmedetomidine Combined with Low Concentrations of Ropivacaine for Postoperative Analgesia in Elderly Knee Arthroplasty

Abstract

Objectives: This study aims to investigate the clinical effect of dexmedetomidine (DEX) combined with low concentrations of ropivacaine in ultrasound-guided continuous fem­oral nerve block for postoperative analgesia in elderly patients with total knee arthroplasty (TKA). Materials and Methods: Patients were divided into three groups: group C, group D1, and group D2. For postoperative analgesia, patients in group C were given 0.15% ropivacaine, patients in group D1 were given 0.15% ropivacaine + 0.02 μg × kg–1 × h–1 DEX, and patients in group D2 were given 0.15% ropivacaine + 0.05 μg × kg–1 × h–1 DEX. The visual analogue scores in the resting state, active state (AVAS), and passive functional exercise state (PVAS), degree of joint bending, and Ramsay scores were recorded. Results: The Ramsay scores were significantly higher, AVAS scores were significantly lower, PVAS scores were significantly decreased, the degree of joint bending was significantly higher, and the time to the first postoperative ambulation was shorter in groups D1 and D2 than group C. Furthermore, the time to the first postoperative ambulation was shorter in group D2 than in group D1, patients in groups D1 and D2 were more satisfied than patients in group C, and patients in group D2 were more satisfied than patients in group D1. Conclusion: The protocol of 0.05 μg × kg–1 × h–1 of DEX combined with 0.15% ro­pivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with TKA provides a better analgesic effect than without DEX performance.

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.…”

“…Dexmedetomidine, a highly selective, speci c, and potent a2-adrenergic receptor agonist, is another kind of agents administered in nerve block. Several studies (13,14) demonstrated that dexmedetomidine combined with local anesthetics in nerve block could improve the postoperative analgesia effect and prolong the duration time after TKA. However, the sizes of these studies were small and the results were not so consistent and persuasive.…”

“…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.…”

“…Total complications were recorded in 4 studies (9)(10)(11)14) containing 361 patients. No Signi cant differences were found between the Dex.…”