Postoperative Pain Clinical Trial
Official title:
Comparison of Intra-articular Dexmedetomidine and Magnesium in Postoperative Pain
Arthroscopic meniscus surgeries are the most frequent orthopedic procedures. The objective of the study is to compare the effects of intraarticular local anesthetic and adjuvant (dexmedetomidine vs magnesium) combinations in postoperative pain and analgesic requirement. The investigators' hypothesis is adjuvants added to the local anesthetics decreases the total local anesthetic dose, provides more effective pain relief according to local anesthetic only, and decreases the postoperative systemic non-steroidal analgesic and opioid doses.
Arthroscopic meniscus surgeries are the most frequent orthopedic procedures. However,
irritation of free nerve endings in the synovial tissue and anterior fat pads and stretching
and resection in the joint capsule lead to pain at various levels. Proper pain management
enhances recovery, provides early mobilization and shortens length of hospital stay.
"Opioid-free" analgesia methods are frequently emphasized in published postoperative pain
management guidelines and multimodal treatment approaches such as local anesthetic
infiltration is recommended. In the treatment of knee pain, intra-articular drug injections
are the most commonly used method because of minimal systemic side effects.
The drugs most commonly administered intraarticularly included local anesthetics
(bupivacaine, levobupivacaine, lidocaine), opioids (morphine, fentanyl), magnesium sulfate,
steroids, and α2 agonists (clonidine, dexmedetomidine).
Dexmedetomidine is a selective, specific, lipophilic and potent α2 adrenergic receptor
agonist with sedative, anxiolytic, analgesic, antihypertensive and sympatholytic effects. It
provides analgesic activity through both the central and peripheral nervous system. The
analgesic effects of intra-articular administration of dexmedetomidine in arthroscopic
surgeries have been demonstrated. Most side effects of this drug included hypotension and
bradycardia. However, these side effects have never been encountered with intra-articular
injection of the drug.
Magnesium is also an adjuvant drug which has a key role in nociceptive transmission, and acts
as a NMDA (N-Methyl-D-Aspartate) antagonist in spinal neurons.
While opioid free anesthesia and analgesia methods gain importance nowadays, there has been
increased interest in non-opioid analgesic drugs and multimodal analgesia applications. In
order to increase the effects of local anesthetics and prolong their analgesic times, the
addition of various adjuvants to local anesthetics is frequently used.
In the randomized controlled trials, intraarticular local anesthetic drugs combined with
adjuvant drugs for postoperative analgesia were found to be superior to local anesthetic
drugs alone. It is also known that local anesthetics have negative effects on chondrocytes.
One of the goals of the investigators' in this study is to reduce the amount of local
anesthetic used by adding adjuvant to local anesthetics.
In this study, the investigators plan to compare the efficacy of 2 adjuvants (magnesium
sulfate and dexmedetomidine) combined with local anesthetics to be given intraarticularly for
postoperative pain management after elective arthroscopic surgery.
Intraarticular high-volume drug injections may cause pain due to tension in the joint
capsule. Additionally, the investigators aim to decrease the total drug volume with adjuvant
drugs used in combination with local anesthetic, and thus to prevent joint capsule tension
pain.
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