Intrathecal Dexmedetomidine, Adductor Canal Block, Analgesia, Total Knee Arthroplasty
Conditions
Brief summary
The aim of this work is to evaluate the effect of combined intrathecal dexmedetomidine and adductor canal block for analgesia after total knee arthroplasty (TKA).
Detailed description
Effective postoperative pain management is essential for improving patient outcomes following knee surgery, facilitating early mobilization, and reducing the risk of complications. The adductor canal block (ACB) is a nerve block of Hunters canal, which includes the saphenous and vastus medialis nerves. Additionally, other sensory nerves, such as the femoral nerve, medial cutaneous nerve, and both the anterior branch and terminal end of the posterior branch of the obturator nerve to some extent as it enters the distal part of the canal are blocked by the ACB. Dexmedetomidine (DXM) a highly selective α2 adrenergic agonist with sedative, anxiolytic, analgesic, sympatholytic and antihypertensive effects.
Interventions
Patients will receive 15mg in 3ml hyperbaric bupivacaine intrathecally with 5 μg in 0.5ml dexmedetomidine + adductor canal block using 20 ml saline 0.9% at the end of surgery
DRUGAdductor Canal Block
Patients will receive 15mg in 3ml hyperbaric bupivacaine intrathecally with 0.5ml saline 0.9% + adductor canal block using 20 ml bupivacaine 0.25% at the end of surgery.
DRUGIntrathecal Dexmedetomidine + Adductor Canal Block
Patients will receive 15mg in 3ml hyperbaric bupivacaine intrathecally with 5 μg in 0.5ml dexmedetomidine + adductor canal block using 20 ml bupivacaine 0.25% at the end of surgery.
Sponsors
Kafrelsheikh University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 75 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Scheduled for total knee arthroplasty under spinal anesthesia.
Exclusion criteria
* Patients with neurological or intellectual disability. * History of allergy to local anesthetics or dexmedetomidine . * Infection at the injection site. * Prolonged use of analgesic or sedative medications. * Coagulation abnormalities. * Pregnancy. * Obesity \[body mass index (BMI) \> 30 kg/m2\].
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 48 hours postoperatively | The patient will receive a 3mg bolus of morphine as a rescue analgesic if the visual analog scale (VAS) was greater than 3, and if the pain persisted for more than 30 mins, the injection was repeated until the VAS became below 4 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 48 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the visual analog scale (VAS). VAS (0 represents no pain while 10 represents the worst pain imaginable). VAS will be assessed at 0, 4, 8, 12, 18, 24, 36 and 48 h postoperatively |
| Heart rate | In post-anesthesia care unit (PACU) (Up to 1 hour) | Heart rate will be recorded every 5 minutes till the end of surgery and in post-anesthesia care unit (PACU). |
| Time to the 1st rescue analgesia | 48 hours postoperatively | Time to the 1st rescue analgesia will be recorded from the end of surgery till the first dose of morphine administered. |
| Degree of patient satisfaction | 48 hours postoperatively | Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied) |
| Incidence of adverse events | 48 hours postoperatively | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication will be recorded. |
| Mean arterial pressure | In post-anesthesia care unit (PACU) (Up to 1 hour) | Mean arterial pressure will be recorded every 5 minutes till the end of surgery and in post-anesthesia care unit (PACU). |
Countries
Egypt
Contacts
Primary ContactSherif K Arafa, MD
Outcome results
None listed