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. 2019 May;13(2):91-98.
doi: 10.1177/2049463718796865. Epub 2018 Aug 30.

Evaluation of analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound-guided adductor canal block in patients following anterior cruciate ligament reconstruction surgeries

Deepak Thapa  1 , Vanita Ahuja  1 , Khushboo Pandey  1 , Satinder Gombar  1 , Ravi Gupta  2
Affiliations

Evaluation of analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound-guided adductor canal block in patients following anterior cruciate ligament reconstruction surgeries

Deepak Thapa et al. Br J Pain. 2019 May.

Abstract

Introduction: Local anaesthetic (LA) with highly selective alpha-2 agonist dexmedetomidine has not been evaluated in adductor canal block (ACB) for arthroscopic anterior cruciate ligament (ACL) reconstruction surgeries. The study evaluates postoperative analgesic effect of ropivacaine with adjuvant dexmedetomidine following postoperative ultrasound-guided ACB.

Methods: 105 randomized subjects received ultrasound-guided ACB using 15 mL of 0.5% ropivacaine, with 0.5 µg kg-1 of dexmedetomidine administered perineurally (Group II), intravenously (Group III) or none (Group I). Primary outcome included 24 hours' total morphine consumption postoperatively. Secondary outcomes included haemodynamics and adverse effects.

Results: The postoperative total morphine consumption was significantly reduced till 4 hours in II 0.57 mg (0.98 (0-3)) (p = 0.011) and up to 6 hours in Group III 0.77 mg (1.00 (0-4)) (p = 0.004) compared to Group I. The postoperative total morphine consumption was comparable at 24 hours in Group III 3.57 mg (1.73 (0-8)) and Group II 3.34 mg (1.92 (07)) (p = 1.000). The visual analogue scale (VAS) scores were comparable in all the three groups at all the time intervals studied (p > 0.05). There were no adverse effects observed during the study.

Conclusion: Use of perineural dexmedetomidine with LA for ACB in the postoperative period resulted in significant reduction in total morphine consumption in initial 4 hours as compared to 6 hours with intravenous (IV) dexmedetomidine.

Keywords: Anterior cruciate ligament; dexmedetomidine; postoperative analgesia; saphenous nerve block.

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Conflict of interest statement

Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram showing patient selection and randomization.
Figure 2.
Figure 2.
Postoperative comparison of total morphine consumption (from 0 minutes in PACU to 24 hours) in 105 subjects who received postoperative ACB. Values are presented as mean (SD (range)). *p < 0.05.
Figure 3.
Figure 3.
Preoperative and postoperative comparison of VAS at rest (from 0 minutes in PACU to 24 hours) in 105 subjects who received postoperative ACB. Group I: Ropivacaine in ACB. Group II: ropivacaine and dexmedetomidine in ACB. Group III: ropivacaine in ACB with intravenous dexmedetomidine. Values are presented as median (IQR (range)).
Figure 4.
Figure 4.
Preoperative and postoperative comparison of VAS at movement (from 0 minutes in PACU to 24 hours) in 105 subjects who received postoperative ACB. Group I: ropivacaine in ACB. Group II: ropivacaine and dexmedetomidine in ACB. Group III: ropivacaine in ACB with intravenous dexmedetomidine. Values are presented as median (IQR (range)).
Figure 5.
Figure 5.
Preoperative and postoperative comparison of range of movement (at 12 and 24 hours) in 105 patients who received postoperative ACB. Group I: ropivacaine in ACB. Group II: ropivacaine and dexmedetomidine in ACB. Group III: ropivacaine in ACB with intravenous dexmedetomidine. Values are presented as mean ± SD.
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