Knee Arthroscopy Clinical Trial
Official title:
Intra-articular Versus Intravenous Administration of Dexmedetomidine in Arthroscopic Knee Surgeries: A Prospective Randomized Study
The present study will be carried to evaluate the efficacy of intra-articular 0.5 bupivacaine
with intra-articular or intravenous alpha-2agonist; Dexmedetomidine; for intraoperative
anesthesia and postoperative analgesia after arthroscopic knee surgery.
Arthroscopic knee surgery is one of the most common minimally invasive orthopedic procedures
in recent practice which is frequently performed as a day surgery procedures. It can be done
under general, regional or local anesthesia (LA) with or without sedation. It is associated
with varying amount of postoperative pain. Postoperative pain negatively influences patient's
early ambulation, rehabilitation and psychology which consecutively prolonged the hospital
stay.
Intra-articular administration of local anesthetic for knee arthroscopy is a well-documented
procedure that offers many advantages over other anesthesia types. Many anesthesiologists are
still trying to improve the technique of local anesthetic administration through using many
combinations with LA solutions in order to administer safe anesthesia to those patients and
to obtain a pain-free knee with good operating conditions.
Dexmedetomidine is a highly selective α2 adrenergic agonist. It has analgesic, sedative,
anxiolytic, hypnotic, sympatholytic, antihypertensive properties with anesthetic sparing
effects. It becomes an attractive alternative to the current opioids because it does not have
a respiratory depressant or addictive effect.
All patients were kept fasting after midnight and received midazolam 5 mg orally as
premedication. All patients were premedicated with I.V. midazolam 0.03 mg/kg ten minutes
before starting the operation. The anesthetic technique was standardized for all patients.
All surgical procedures were performed by the same surgeon and consisted of arthroscopic
removal of torn meniscus. Both intra-articular and intravenous solutions were prepared by an
individual not involved in the study and the intra-articular drugs were injected by the
surgeon (without knowing the contents). The anesthesiologist managing and monitoring the
patient throughout the surgery provides IV drugs. No leg holder or tourniquet or surgical
drain was used for any of the cases. After preparation and draping the patient's leg,
patients were warned prior to each needle stick to decrease anxiety. All procedures were
performed under complete aseptic conditions. Skin and subcutaneous tissues at each
arthroscopic portal site were anesthetized with LA consisting of injection of a mixture of 2%
lidocaine 5 mL with 1:200,000 epinephrine.
Care should be taken to avoid infiltration of the fat pad. It is a relatively aneural
structure; as, too much local infiltration allows it to bulge out into the joint during the
surgery. Flexion and extension of the knee joint several times help to spread of
intra-articular solution and then waiting 20 minutes for anesthesia to take effect is helpful
before the surgical incision.
The arthroscope was inserted into the knee, and inflow through the sheath was established. No
pump was used for the saline inflow which was maintained through the arthroscope by the
gravity. Gravity outflow drained through the superolateral portal. A separate egress cannula
was used if indicated. The patient was encouraged to view the video monitor during the
procedure. Constant verbal communication between the surgeon and the patient is important
throughout the arthroscopic examination and surgery. This keeps the patient anxiety and
muscle tension to the minimum which facilitates manipulation of the leg and thorough
examination of the entire joint. Once finishing, instruments were removed and portals were
closed with a 4-0 absorbable suture subcutaneously and steri-strips. A compression dressing
was applied for three days to the knee.
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