Pain, Postoperative
Conditions
Keywords
adductor canal regional block, anaesthesia for knee arthroscopic surgeries
Brief summary
a comparison shall be conducted between dexamethasone accompanied by bupivacaine, on one hand, and dexmedetomedine accompanied by bupivacaine on the other hand and a control group for pain-free knee arthroscopic surgeries.
Detailed description
Arthroscopic knee surgery can cause significant postoperative pain to the degree that can potentially delay timely discharge from the ambulatory surgical setting. Analgesia after knee surgery can be provided by multiple, non-systemic, non-opioid-based methods, including local anesthetic infiltration, peripheral nerve blockade, neuraxial procedures, and intra-articular injections. The femoral nerve block has been shown to be superior to traditional intra-articular injection of local anesthetics in some knee surgeries, but motor blockade of the quadriceps muscle, with the potential risk for falls, limits the value of femoral blocks for less invasive ambulatory surgery. Orthopedic surgery is increasingly being performed on an ambulatory basis, where perioperative analgesia can improve timely discharge in the outpatient setting.
Interventions
PROCEDURESpinal anaesthesia
spinal anesthesia shall be conducted with 2.5 ml 0.5% hyperbaric bupivacaine at the L3/4 interspaces in the setting position.
PROCEDUREultrasound-guided Adductor Canal Block + dexamethasone
Ultrasound blocks will be done immediately after spinal anesthesia, before surgical intervention. A high-frequency linear ultrasound transducer was placed transverse to the longitudinal axis of the extremity at the midthigh level at a distance approximately halfway between the iliac spine and the patella. The femoral artery was identified underneath the sartorius muscle with the vein just underneath the artery. At this position, the saphenous nerve was placed lateral to the artery in the adductor canal (Fig. 1). A 10 cm Tuohy canula 18G Gauge (Braun Medical, Melsungen, Germany) was inserted, in plane, from the lateral side of the transducer, through the sartorius muscle with the tip placed lateral to the artery. then, a 20-ml mixture of 0.25% bupivacaine, and 4 mg dexamethasone will be injected.
PROCEDUREultrasound-guided Adductor Canal Block + dexmedetomedine
Ultrasound blocks will be done immediately after spinal anesthesia, before surgical intervention. A high-frequency linear ultrasound transducer was placed transverse to the longitudinal axis of the extremity at the midthigh level at a distance approximately halfway between the iliac spine and the patella. The femoral artery was identified underneath the sartorius muscle with the vein just underneath the artery. At this position, the saphenous nerve was placed lateral to the artery in the adductor canal (Fig. 1). A 10 cm Tuohy canula 18G Gauge (Braun Medical, Melsungen, Germany) was inserted, in plane, from the lateral side of the transducer, through the sartorius muscle with the tip placed lateral to the artery.then, a 20-ml mixture of 0.25% bupivacaine, and 0.5 Mg/kg dexmedetomidine will be injected.
Ultrasound blocks will be done immediately after spinal anesthesia, before surgical intervention. A high-frequency linear ultrasound transducer was placed transverse to the longitudinal axis of the extremity at the midthigh level at a distance approximately halfway between the iliac spine and the patella. The femoral artery was identified underneath the sartorius muscle with the vein just underneath the artery. At this position, the saphenous nerve was placed lateral to the artery in the adductor canal (Fig. 1). A 10 cm Tuohy canula 18G Gauge (Braun Medical, Melsungen, Germany) was inserted, in plane, from the lateral side of the transducer, through the sartorius muscle with the tip placed lateral to the artery.then, a 20-ml mixture of 0.25% bupivacaine
Sponsors
Rasha Hamed
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
19 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
- * Adult patients of aged more than 18 years old ASA American Society of Anaesthesia * physical status I or II under-going any unilateral knee arthroscopy.
Exclusion criteria
- * patient refusal. * Pre-existing pain ; postoperative pain similar to preoperative pain * Known contraindications to peripheral nerve block, including local skin infections, bleeding diathesis, and coagulopathy. * Allergies to local anesthetics, dexmedetomidine, or any component of multimodal analgesia.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dynamic Visual Analogue Scale score | month 1 postoperative | a scale of 11 points. 0 = no pain, 10=worst pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dynamic Visual Analogue Scale score | month 3 postoperative | a scale of 11 points. 0 = no pain, 10=worst pain |
| 24 hours opioid analgesia consumed | 24 hours postoperative | — |
| Visual Analogue Scale score | 24 hours postoperative | a scale of 11 points. 0 = no pain, 10=worst pain |
| month 3 opioid analgesia | month 3 postoperative | amount of oral codeine consumed postoperative |
Countries
Egypt
Outcome results
None listed