Comparison of Two Doses of Dexmedetomidine As Adjuvant to Ropivacaine in Ultrasound Guided Adductor Canal Block: Randomised Double-Blind Controlled Trial
,
Abstract
Background: Adjuvants to local anesthetics (LA) have proven to prolong the analgesic efficacy of Adductor canal block (ACB). The ACB when administered with lower dose of LA produces analgesia without loss of motor control of the thigh. Hence we studied the efficacy of two different doses of dexmedetomidine in ACB to prolong postoperative analgesia when used as adjuvant to ropivacaine.
Methods: Total of 90 patients between 18-65years undergoing arthroscopic ligament reconstructions surgeries of knee were randomized into three groups and given Ultrasound guided (USG) ACB. Group A - 0.2% Ropivacaine, Group B – 0.2% Ropivacaine plus Dexmedetomidine 0.50 mcg.kg-1 and Group C- 0.2% Ropivacaine plus Dexmedetomidine 1 mcg.kg-1. Primary aim of our intervention was to study the duration of post-operative analgesia and Secondary aim was to study the total dose of rescue analgesic required in 24hrs, success of early ambulation, level of patient satisfaction and any adverse effects.
Results: The duration of analgesia was found highest in Group C (1166 ±200mins) than Group A (420±100mins) and Group B (702± 150mins). The total dose of tramadol consumption in 24 hours was highest in Group A. The number of steps walked postoperatively after 24 hours and level of patient satisfaction was maximum with Group C.
Conclusion: Use of 1mcg.kg-1 of dexmedetomidine as adjuvant to 0.2% ropivacaine in ACB after arthroscopic knee surgeries significantly prolongs the duration of postoperative analgesia, reducing the total requirement of rescue analgesic without causing any untoward effects and preserving quadriceps strength aiding in early ambulation and recovery.
[2] Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2013; 110(6):915-25.
[3] Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty's Stationery Office: 1942; pp 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O'Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 figures.
[4] Burckett-St Laurant D, Peng P, Girón Arango L, Niazi AU, Chan VW, et al. The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study. Reg Anesth Pain Med. 2016; 41(3):321-7.
[5] Bonet A, Koo M, Sabaté A, Otero I, Bocos J, Pi A. Ultrasound-guided saphenous nerve block is an effective technique for perioperative analgesia in ambulatory arthroscopic surgery of the internal knee compartment. Rev Esp Anestesiol Reanim. 2015; 62(8):428-35.
[6] Hanson NA, Derby RE, Auyong DB, Salinas FV, Delucca C, Nagy R, et al. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial. Can J Anaesth. 2013; 60(9):874-80.
[7] Thapa D, Ahuja V, Pandey K, Gombar S, Gupta R. Evaluation of analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound-guided adductor canal block in patients following anterior cruciate ligament reconstruction surgeries. Br J Pain. 2019; 13(2):91-98.
[8] Grevstad U, Mathiesen O, Lind T, Dahl JB. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis. Br J Anaesth. 2014; 112(5):912-9.
[9] Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011; 55(2):104-10.
[10] Perlas A, Kirkham KR, Billing R, Tse C, Brull R, Gandhi R, Chan VW. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013; 38(4):334-9
[11] Nallam SR, Chiruvella S, Karanam S. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial. Indian J Anaesth. 2017; 61(3):256-261.
[12] Memary E, Mirkheshti A, Dabbagh A, Taheri M, Khadempour A, Shirian S. The Effect of Perineural Administration of Dexmedetomidine on Narcotic Consumption and Pain Intensity in Patients Undergoing Femoral Shaft Fracture Surgery; A Randomized Single-Blind Clinical Trial. Chonnam Med J. 2017; 53(2):127-132.
[13] Yun SH, Park JC, Kim SR, Choi YS. Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia. Acta Med Okayama. 2016;70(1):37-43.
[14] Abdulatif M, Fawzy M, Nassar H, Hasanin A, Ollaek M, Mohamed H. The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study. Anaesthesia. 2016; 71(10):1177-85.
[15] Goyal R, Mittal G, Yadav AK, Sethi R, Chattopadhyay A. Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine. Indian J Anaesth. 2017; 61(11):903-909.
[16] Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi J Anaesth. 2015; 9(2):148-54.
[17] Ortiz-Gómez JR, Perepérez-Candel M, Vázquez-Torres JM, Rodriguez-Del Río JM, Torrón-Abad B, Fornet-Ruiz I, et al. Postoperative analgesia for elective total knee arthroplasty under subarachnoid anesthesia with opioids: comparison between epidural, femoral block and adductor canal block techniques (with and without perineural adjuvants). A prospective, randomized, clinical trial. Minerva Anestesiol. 2017; 83(1):50-58.
[18] Packiasabapathy SK, Kashyap L, Arora MK, Batra RK, Mohan VK, Prasad G, et al. Effect of dexmedetomidine as an adjuvant to bupivacaine in femoral nerve block for perioperative analgesia in patients undergoing total knee replacement arthroplasty: A dose-response study. Saudi J Anaesth. 2017; 11(3):293-298
[19] Sinha C, Kumar A, Kumari P, Singh AK, Sharma S, Kumar A, et al. Comparison of Two Doses of Dexmedetomidine for Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial. Anesth Essays Res. 2018; 12(2):470-474.
| Files | ||
| Issue | Vol 8 No 2 (2022): Spring |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i2.9150 | |
| Keywords | ||
| Adductor canal block Arthroscopic ligament reconstructions knee surgeries Dexmedetomidine Local Anesthetics Ropivacaine Ultrasound guided | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
