Analgesic effect of intra-articular injection of dexmedetomidine combined with ropivacaine after arthroscopic knee surgery: a prospective, randomized and controlled trial
Wang Taotao, Zhai Ming, Guo Rui, Wang Nanhai
Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract:Objective To investigate the effect of intra-articular administration of dexmedetomidine combined with ropivacaine on postoperative analgesia after knee arthroscopy.Methods A prospective, randomized and controlled trial was conducted in 90 patients undergoing arthroscopic knee surgery from the First Affiliated Hospital of Bengbu Medical College from June 2015 to December 2016, including 54 patients of loose body of knee joint and 36 patients of meniscus injury. They were randomly divided into 3 groups, 30 patients in each group. At the end of the surgery, the analgesics were respectively injected into the articular cavity. Patients who were given the mixture of 14 mL of 0.25% ropivacaine and 1 mL normal saline served as the ropivacaine group (R group), and patients received the mixture of 14 mL of 0.25% ropivacaine and 0.5 μg/kg dexmedetomidine and 1 mL normal saline served as the low-dose dexmedetomidine and ropivacaine group (RD1 group), while patients received the mixture of 14 mL of 0.25% ropivacaine and 1.0 μg/kg dexmedetomidine and 1 mL normal saline served as the high-dose dexmedetomidine and ropivacaine group (RD2 group). Then the pain scores at rest and during movement were assessed with VAS at 1, 2, 4, 6, 8, 12, 24 h postoperatively. Moreover, the time to the first postoperative analgesic request, consumption of dezocine at 24 h after surgery and related adverse events were recorded and analyzed.Results There was no significant difference in gender, age, weight, height, operation time and the type distribution between the three groups (all P values>0.05). At rest and during movement, the VAS score of the three groups was the lowest at 1 h after the surgery and gradually increased, reaching the peak at 8 h after surgery; and the differences of VAS scores in different groups at different time points after surgery were statistically significant (F=178.116, 90.791, all P values<0.01); the differences between each two groups were statistically significant (F=21.258, 23.521, all P values<0.01). At different time points, VAS scores of RD2 group were lower than those of RD1 group, and RD1 group was lower than R group; meanwhile, the differences of VAS scores at 1, 2, 4, 6 h after surgery had statistical significance (all P values<0.05), but the difference at 8, 12, 24 h after surgery had no statistical significance (all P values>0.05). The time to the first postoperative analgesic request was longer in the RD1 group and RD2 group than that in the R group (all P values<0.05), and the RD2 group was longer than RD1 group (P<0.05). The consumption of dezocine at 24 h after surgery in the RD1 group and RD2 group was significantly less than that in the group R (all P values<0.05), and the RD2 group was less than the RD1 group (P<0.05). There was no adverse events, such as somnolence, bradycardia, hypotension, hypoxemia, nausea and vomiting, in the three groups within 24 h after surgery.Conclusions The analgesic effect of dexmedetomidine combined with ropivacaine on postoperative pain after arthroscopic knee surgery is better than that of ropivacaine alone, and the efficacy is in a dose-dependent manner.
王涛涛, 翟明, 郭睿, 王南海. 关节腔注射右美托咪定联合罗哌卡因对膝关节镜术后镇痛剂量效应的前瞻性随机对照研究[J]. 中华解剖与临床杂志, 2017, 22(5): 392-396.
Wang Taotao, Zhai Ming, Guo Rui, Wang Nanhai. Analgesic effect of intra-articular injection of dexmedetomidine combined with ropivacaine after arthroscopic knee surgery: a prospective, randomized and controlled trial. Chinese Journal of Anatomy and Clinics, 2017, 22(5): 392-396.
Al-Metwalli RR, Mowafi HA, Ismail SA, et al. Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery[J]. Br J Anaesth, 2008, 101(3): 395-399. DOI:10.1093/bja/aen184.
[5]
Imani F, Entezary S, Razi M, et al. The effect of intra-articular meperidine and bupivacaine 0.5% on postoperative pain of arthroscopic knee surgery; a randomized double blind clinical trial[J]. Anesth Pain Med, 2015, 5(1): e27470. DOI:10.5812/aapm.27470.
Campo MM, Kerkhoffs GM, Sierevelt IN, et al. A randomised controlled trial for the effectiveness of intra-articular Ropivacaine and Bupivacaine on pain after knee arthroscopy: the DUPRA (DUtch Pain Relief after Arthroscopy)-trial[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 239-244. DOI:10.1007/s00167-011-1562-5.
[9]
Karhade SS, Sardesai SP. 0.2% ropivacaine with fentanyl in the management of labor analgesia: A case study of 30 parturients[J]. Anesth Essays Res, 2015, 9(1): 83-87. DOI:10.4103/0259-1162.151238.
[10]
Wang X, Jia D, Chen X, et al. Comparison of intra-articular low-dose sufentanil, ropivacaine, and combined sufentanil and ropivacaine on post-operative analgesia of isolated anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(5): 1140-1145. DOI:10.1007/s00167-012-2326-6.
[11]
Dalkilic N, Tuncer S, Burat I. Dexmedetomidine augments the effect of lidocaine: power spectrum and nerve conduction velocity distribution study[J]. BMC Anesthesiol, 2015, 15: 24. DOI:10.1186/s12871-015-0009-9.
[12]
Shukla U, Prabhakar T, Malhotra K, et al. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: a comparative evaluation[J]. Indian J Anaesth, 2015, 59(4): 234. DOI:10.4103/0019-5049.155001.
[13]
Brummett CM, Hong EK, Janda AM, et al. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current[J]. Anesthesiology, 2011, 115(4): 836-843. DOI:10.1097/ALN.0b013e318221fcc9.
[14]
Gu XY, Liu BL, Zang KK, et al. Dexmedetomidine inhibits Tetrodotoxin-resistant Nav1.8 sodium channel activity through Gi/o-dependent pathway in rat dorsal root ganglion neurons[J]. Mol Brain, 2015, 8:15. DOI:10.1186/s13041-015-0105-2.
[15]
Marhofer D, Kettner SC, Marhofer P, et al. Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study[J]. Br J Anaesth, 2013, 110(3): 438-442. DOI:10.1093/bja/aes400.
[16]
Gómez-Vázquez ME, Hernández-Salazar E, Hernández-Jiménez A, et al. Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery[J]. J Clin Anesth, 2007, 19(8): 576-582. DOI:10.1016/j.jclinane.2007.06.013.