<p>The Effect Of Dexmedetomidine As Adjuvant To Ropivacaine 0.1% For Femoral Nerve Block On Strength Of Quadriceps Muscle In Patients Undergoing Total Knee Arthroplasty: A Double-Blinded Randomized Controlled Trial</p>

Abstract

BackgroundFemoral nerve block (FNB) has been considered as an excellent analgesic modality in total knee arthroplasty (TKA) pain control. However, relatively high concentration of ropivacaine could lead to quadriceps muscle weakness and increase the risk of postoperative falls.ObjectiveThis double-blinded randomized controlled study was designed to investigate the effect of a combination of dexmedetomidine with a lower concentration of ropivacaine on quadriceps muscle strength and analgesic effect in FNB.MethodsA total of 90 patients scheduled for TKA were randomized to receive continuous FNB postoperatively using 0.2% ropivacaine (H group), 0.1% ropivacaine (L group) or 0.1% ropivacaine combined with 2 μg/kg dexmedetomidine (LD group). Meanwhile, intravenous patient-controlled analgesia with morphine was administered to patients. The primary endpoint was the strength of quadriceps muscle evaluated by manual muscle testing (MMT) and Timed Up and Go test (TUG). The secondary endpoint was the pain scores and morphine consumption among different groups.ResultsFor MMT, LD group showed higher quadriceps muscle strength than the other two groups (P<0.05) at 12 hrs postoperatively. TUG test was conducted to measure the walking ability, and showed that scores were significantly better in LD group than those in H group and L group (P<0.05) at 24 and 48 hrs postoperatively. There was no significant difference between H and LD group in the numeric rating scales (NRS) scores both at rest and at 45° flexion. The total morphine consumption in L group was significantly higher than in H or LD group (P<0.001).ConclusionCollectively, the addition of dexmedetomidine 2 μg/kg to 0.1% ropivacaine preoperatively would preserve quadriceps muscle strength with satisfactory analgesia in patients undergoing TKA. (This study was registered at ClinicalTrials.gov, identifier NCT03658421).

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. A total of 7 RCTs involving 546 participants were ultimately included in this meta-analysis (8)(9)(10)(11)(12)(13)(14). The PRISMA ow diagram is presented in Fig.…”

“…Dexmedetomidine, a highly selective, speci c, and potent α-2 adrenergic receptor agonist, has bene cial analgesic effects for anesthetic procedures. Several studies (13,14) have demonstrated that dexmedetomidine combined with local anesthetics can improve the postoperative analgesic effect and further prolong the duration of time after TKA. However, the size of these studies have been very small and the results are also inconsistent and not persuasive.…”

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.…”

“…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.…”

Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: A systematic review and meta-analysis

“…Recent studies and meta-analyses indicate that DEX possesses favorable effects in prolonging the duration of peripheral nerve block, improving the efficacy of pain relief and reducing narcotic consumption [15][16][17][18]. Accordingly, growing evidence have elucidated the anti-inflammatory, sleep-promoting and supplemental analgesic effects of adding DEX to local anesthetics for FNB [19][20][21][22][23][24][25][26][27]. Considering these emerging studies, we carried out the present systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the benefit and effectiveness of DEX as adjuvants to local anesthetics for FNB.…”