Pain relief after Arthroscopic Knee Surgery: A comparison of intra-articular ropivacaine, fentanyl, and dexmedetomidine: A prospective, double-blinded, randomized controlled study

Abstract

Background:Postoperative pain is very common distressing symptom after any surgical procedure. Different drugs in different routes have been used for controlling post-arthroscopic pain. No one proved to be ideal. We have compared the analgesic effect of ropivacaine, fentanyl, and dexmedetomidine when administered through the intra-articular route in arthroscopic knee surgery.Materials and Methods:From March 2008 to July 2010, 99 patients undergoing arthroscopic knee surgery were randomly assigned into three groups (A,B,C) in a prospective double-blinded fashion. Group A received 10 ml of 0.75% ropivacaine, where Group B received 50 μg fentanyl, and Group C received 100 μg of dexmedetomidine through the intra-articular route at the end of procedure. Pain assessed using visual analog scale and diclofenac sodium given as rescue analgesia when VAS >4. Time of first analgesia request and total rescue analgesic used in 24 hours were calculated.Results:Demographic profiles are quite comparable among the groups. Time for requirement of first postoperative rescue analgesia in Group A was 380.61 ± 22.973 min, in Group B was 326.82 ± 17.131 min and in Group C was 244.09 ± 20.096 minutes. Total rescue analgesia requirement was less in Group A (1.394 ± 0.496) compared to Group B (1.758 ± 0.435) and Group C (2.546 ± 0.546). Group A had higher mean VAS score at 6th and 24th postoperative hours. No side effects found among the groups.Conclusion:Therefore, it suggests that intra-articular ropivacaine gives better postoperative pain relief, with increased time of first analgesic request and decreased need of total postoperative analgesia compared to fentanyl and dexmedetomidine.

Safety and analgesic efficacy of intravenous dexmedetomidine in arthroscopic knee surgery

“…who used dexmedetomidine, fentanyl, and ropivacaine through intraarticular route. [ 23 ] Analgesia provided postoperatively by subarachnoid block may have contributed to the delayed request for analgesia in comparison to our study, in which general anesthesia was used in all patients.…”

“…Previous studies have evaluated the analgesic efficacy of dexmedetomidine through intraarticular, intravenous routes, and buccal/intramuscular premedication for knee arthroscopies. [ 3 20 21 22 23 24 25 26 27 ] However, we are unaware of any study that has tried to evaluate the adjunctive use of intravenous dexmedetomidine with intraarticular bupivacaine in arthroscopic knee surgery.…”

“…The overall safety profile of dexmedetomidine in aspects of nausea, vomiting, respiratory depression and sedation is in agreement with previous literature. [ 23 14 ]…”

“…Intraarticular infiltration of dexmedetomidine has been used either alone or in combination with local anesthetics to provide postoperative analgesia in arthroscopic knee surgeries with reasonable success. [ 20 21 22 23 24 ] The intraarticular route of drug administration has predominantly relied on the direct local action of dexmedetomidine on the free nerve terminals in the joint space for producing analgesia. Dexmedetomidine in addition to its peripheral effects has well-recognized central mechanisms of analgesia.…”

Pain Relief after Arthroscopic Knee Surgery- Intra-Articular Dexmedetomidine and Fentanyl: A Randomized Control Study

“…16 Manuar M et al in their study compared intraarticular ropivacaine ,fentanyl and dexmedetomidine for pain relief and suggested that ropivacaine was better than both fentanyl and dexmedetomidine. 17 From above studies it can be summarized that intra-articular fentanyl alone cannot produce prolonged analgesia. But dexmedetomidine alone can be used as a potent intraarticular analgesic for postoperative pain management.…”