The efficacy of adding dexmedetomidine perineurally in fascia iliaca compartment block versus intravenously in hip arthroscopy: A randomized controlled trial

Abstract

Background: Stable hemodynamics in hip arthroscopy is one of the most important tasks. Recently, dexmedetomidine has been considered a safe analgesic and sedative adjuvant in different surgeries. Ultrasound-guided fascia iliaca compartment block (FICB) is a technique used to produce postoperative analgesia for hip surgery. FICB will be a promising technique for postoperative analgesia in hip arthroscopy. Objective: We designed a prospective, randomized, double-blind, parallel-group trial to evaluate the effect of administration of dexmedetomidine intravenously and perineurally on hemodynamic stability intraoperatively and on narcotics consumption postoperatively, as well as to evaluate the effect of dexmedetomidine as an adjuvant to FICB. Patients: A total of 88 patients scheduled for elective hip arthroscopy, aged 18 to 65 years, 70-80 kg, both sexes. Patients were randomized into Group A (intravenous Dexmedetomidine) and Group B (perineural Dexmedetomidine). The Main outcome measure was to detect effectiveness of dexmedetomidine infusion without loading dose in achieving intraoperative hemodynamic stability with minimal need for rescue agents and its analgesic effect postoperatively, if added to bupivacaine in fascia iliaca block. Results: Dexmedetomidine significantly maintained mean arterial blood pressure and heart rate (P-value <0.001); with lower intraoperative fentanyl consumption in group A (53.85 ± 13.87 µg) when compared to group B (150.00 ± 40.35 µg) and no significant difference between the two groups in VAS scores postoperatively. Conclusions: Dexmedetomidine infusion provided stable intraoperative hemodynamics in patients undergoing hip arthroscopy with reduced intraoperative narcotics requirement, while addition of dexmedetomidine to bupivacaine had no role in prolonging the effect of FICB.

Blocks and adjuvants: Lost in research methodology

“…Currently, two are the most studied drugs looking for an optimal long-lasting single-shot nerve block. In this issue of Revista Chilena de Anestesia, two trials analyzed the effect of adjuvants in perioperative nerve blocks with interesting results [3], [4]. For a better interpretation, this editorial summarizes the evidence of these adjuncts and describes what we deem as relevant research questions that need to be answered and what we think are the lines that research should follow on this topic.…”