DOI QR코드

DOI QR Code

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

  • Ismail, Eman A. (Department of Anesthesia, Faculty of Medicine, Assiut University) ;
  • Sayed, Jehan A. (Department of Anesthesia, Faculty of Medicine, Assiut University) ;
  • Bakri, Mohamed H. (Department of Anesthesia, Faculty of Medicine, Assiut University) ;
  • Mahfouz, Reda Z. (Department of Clinical Pathology, Faculty of Medicine, Menoufia University)
  • Received : 2016.12.13
  • Accepted : 2017.03.22
  • Published : 2017.04.01

Abstract

Background: Postoperative 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. Methods: Ninety 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. Results: Dexmedetomidine 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. Conclusions: Both 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.

Keywords

References

  1. Bondok RS, Abd El-Hady AM. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anaesth 2006; 97: 389-92. https://doi.org/10.1093/bja/ael176
  2. Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, et al. IV and Perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: a randomized, three-arm, triplemasked, placebo-controlled trial. Anesthesiology 2016; 124: 683-95. https://doi.org/10.1097/ALN.0000000000000983
  3. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006; 50: 222-7. https://doi.org/10.1111/j.1399-6576.2006.00919.x
  4. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J 2009; 30: 365-70.
  5. Al-Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM, et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: a double blind controlled study. Am J Appl Sci 2009; 6: 882-7. https://doi.org/10.3844/ajassp.2009.882.887
  6. Paul S, Bhattacharjee DP, Ghosh S, Dawn S, Chatterjee N. Efficacy of intra-articular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery. Ceylon Med J 2010; 55: 111-5. https://doi.org/10.4038/cmj.v55i4.2627
  7. Al-Metwalli RR, Mowafi HA, Ismail SA, Siddiqui AK, Al-Ghamdi AM, Shafi MA, et al. Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery. Br J Anaesth 2008; 101: 395-9. https://doi.org/10.1093/bja/aen184
  8. Manuar MB, Majumdar S, Das A, Hajra BK, Dutta S, Mukherjee D, et al. Pain relief after arthroscopic knee surgery: a comparison of intra-articular ropivacaine, fentanyl, and dexmedetomidine: a prospective, double-blinded, randomized controlled study. Saudi J Anaesth 2014; 8: 233-7. https://doi.org/10.4103/1658-354X.130727
  9. Vanderstappen C, Verhoeven N, Stuyck J, Bellemans J. Intra-articular versus serum C-reactive protein analysis in suspected periprosthetic knee joint infection. Acta Orthop Belg 2013; 79: 326-30.
  10. Bekker A, Haile M, Kline R, Didehvar S, Babu R, Martiniuk F, et al. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery. J Neurosurg Anesthesiol 2013; 25: 16-24. https://doi.org/10.1097/ANA.0b013e31826318af
  11. Parker MJ, Manan A, Duffett M. Rapid, easy, and cheap randomization: prospective evaluation in a study cohort. Trials 2012; 13: 90. https://doi.org/10.1186/1745-6215-13-90
  12. Black AS, Newcombe GN, Plummer JL, McLeod DH, Martin DK. Spinal anaesthesia for ambulatory arthroscopic surgery of the knee: a comparison of low-dose prilocaine and fentanyl with bupivacaine and fentanyl. Br J Anaesth 2011; 106: 183-8. https://doi.org/10.1093/bja/aeq272
  13. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 2: 656-9. https://doi.org/10.1136/bmj.2.5920.656
  14. Rifai N, Tracy RP, Ridker PM. Clinical efficacy of an automated high-sensitivity C-reactive protein assay. Clin Chem 1999; 45: 2136-41.
  15. Hamwi A, Vukovich T, Wagner O, Rumpold H, Spies R, Stich M, et al. Evaluation of turbidimetric high-sensitivity C-reactive protein assays for cardiovascular risk estimation. Clin Chem 2001; 47: 2044-6.
  16. Wang SS, Hu SW, Zhang QH, Xia AX, Jiang ZX, Chen XM. Mesenchymal stem cells stabilize atherosclerotic vulnerable plaque by anti-inflammatory properties. PLoS One 2015; 10: e0136026. https://doi.org/10.1371/journal.pone.0136026
  17. Dupont WD, Plummer WD Jr. Power and sample size calculations for studies involving linear regression. Control Clin Trials 1998; 19: 589-601. https://doi.org/10.1016/S0197-2456(98)00037-3
  18. Hayashi Y, Maze M. Alpha 2 adrenoceptor agonists and anaesthesia. Br J Anaesth 1993; 71: 108-18. https://doi.org/10.1093/bja/71.1.108
  19. Niu XY, Ding XB, Guo T, Chen MH, Fu SK, Li Q. Effects of intravenous and intrathecal dexmedetomidine in spinal anesthesia: a meta-analysis. CNS Neurosci Ther 2013; 19: 897-904. https://doi.org/10.1111/cns.12172
  20. Mohamed AA, Fares KM, Mohamed SA. Efficacy of intrathecally administered dexmedetomidine versus dexmedetomidine with fentanyl in patients undergoing major abdominal cancer surgery. Pain Physician 2012; 15: 339-48.
  21. De Kock M, Gautier P, Fanard L, Hody JL, Lavand'homme P. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study. Anesthesiology 2001; 94: 574-8. https://doi.org/10.1097/00000542-200104000-00008
  22. Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology 1996; 85: 655-74. https://doi.org/10.1097/00000542-199609000-00026
  23. Nakamura M, Ferreira SH. Peripheral analgesic action of clonidine: mediation by release of endogenous enkephalinlike substances. Eur J Pharmacol 1988; 146: 223-8. https://doi.org/10.1016/0014-2999(88)90296-8
  24. Khan AL, Singh RB, Tripathi RK, Choubey S. A comparative study between intrathecal dexmedetomidine and fentanyl as adjuvant to intrathecal bupivacaine in lower abdominal surgeries: a randomized trial. Anesth Essays Res 2015; 9: 139-48. https://doi.org/10.4103/0259-1162.156284
  25. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol 2011; 27: 339-43. https://doi.org/10.4103/0970-9185.83678
  26. Liang X, Zhou M, Feng JJ, Wu L, Fang SP, Ge XY, et al. Efficacy of dexmedetomidine on postoperative nausea and vomiting: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8: 12113-34.
  27. Safari F, Aminnejad R, Mohajerani SA, Farivar F, Mottaghi K, Safdari H. Intrathecal dexmedetomidine and fentanyl as adjuvant to bupivacaine on duration of spinal block in addicted patients. Anesth Pain Med 2016; 6: e26714.
  28. Margheritini F, Camillieri G, Mancini L, Mariani PP. C-reactive protein and erythrocyte sedimentation rate changes following arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2001; 9: 343-5. https://doi.org/10.1007/s001670100232

Cited by

  1. Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy vol.24, pp.2, 2017, https://doi.org/10.1080/22201181.2018.1444443
  2. Comparison of Efficacy of Intra-Articular Plain Bupivacaine and Bupivacaine with Adjuvants (Dexmedetomidine and Magnesium Sulfate) for Postoperative Analgesia in Arthroscopic Knee Surgeries: A Prospec vol.12, pp.4, 2017, https://doi.org/10.4103/aer.aer_153_18
  3. Intra-Articular Morphine versus Dexmedetomedine for Knee Arthroscopy under Local Anesthesia vol.13, pp.1, 2019, https://doi.org/10.4103/aer.aer_154_18
  4. Value of Anterior Band of the Inferior Glenohumeral Ligament Area as a Morphological Parameter of Adhesive Capsulitis vol.2019, pp.None, 2017, https://doi.org/10.1155/2019/9301970
  5. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis vol.123, pp.6, 2019, https://doi.org/10.1016/j.bja.2019.07.027
  6. Effect of intra-articular dexmedetomidine on experimental osteoarthritis in rats vol.16, pp.1, 2021, https://doi.org/10.1371/journal.pone.0245194