Citation Information :
Naik SS, Patil C, Venkategowda C, Reddy N. A Comparative Study of Dexmedetomidine and Fentanyl as Adjuvants with Bupivacaine in Adductor Canal Block Regional Anesthesia in Total Knee Replacement Surgery. J Recent Adv Pain 2020; 6 (1):4-9.
Background/objectives: Total knee replacement surgeries being the ultimate operative modality are commonly performed for severe osteoarthritis. The challenges for the anesthesiologists are to provide optimal postoperative analgesia with minimum motor blockade, so that the patients can be ambulated early, thereby minimizing the complications of delayed ambulation. Materials and methods: We compared the efficacy of fentanyl and dexmedetomidine in improving the analgesic efficacy of bupivacaine-driven regional anesthesia adductor canal block (ACB) in 60 patients who underwent total knee replacement surgeries. We conducted a randomized study of two different drug formulations for the same procedure with random allocation using a computerized table. Results: The visual analog scale (VAS) score of the patients was less in group D. The number of steps walked and the time taken to stand from supine position was better in group D. The amount of local anesthetic requirement was less in group D. Nonsteroidal anti-inflammatory drug (NSAID) requirement was comparable in both the groups. Conclusion: In our study, we observed that VAS score is less in group D, thereby promoting early ambulation and better patient satisfaction. Hence, dexmedetomidine is a better adjuvant than fentanyl for regional anesthesia.
Jiang X, Wang Q-Q, Wu C-A, et al. Analgesic efficacy of adductor canal block in total knee arthroplasty: a meta-analysis and systematic review. Orthopaedic Surgery 2016;8(3):294–300. DOI: 10.1111/os.12268.
Bansal P. Dexmedetomidine as an adjuvant to local anaesthetic agents in peripheral nerve blocks: a review. Journal of Clinical and Diagnostic Research 2019;13(1):UE01–UE07. DOI: 10.7860/JCDR/2019/38311.12494.
Patel AA, Buller LT, Fleming ME, et al. National trends in ambulatory surgery for upper extremity fractures: a 10-year analysis of the US national survey of ambulatory surgery. Hand (NY) 2015;10(2):254–259.
Cozowicz C, Poeran J, Zubizarreta N, et al. Trends in the use of regional anaesthesia: neuraxial and peripheral nerve blocks. Reg Anaesth Pain Med 2016;41(1):43–49. DOI: 10.1097/AAP.0000000000000342.
Packiasabapathy S, Kashyap L, Arora M, et al. Effect of dexmedetomidine as an adjuvant to bupivacaine in femoral nerve block for perioperative analgesia in patients undergoing total knee replacement arthroplasty: a dose-response study. Saudi J Anaesth 2017;11(3):293–298. DOI: 10.4103/sja.SJA_624_16.
Jæger P, Koscielniak-Nielsen ZJ, Schrøder HM, et al. Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study. PLoS One. 2014;9(11):e111951. DOI: 10.1371/journal.pone.0111951.
Lund J, Jenstrup MT, Jaeger P, et al. Continuous Adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 2011;55(1):14–19. DOI: 10.1111/j.1399-6576.2010.02333.x.
Horn JL, Pitsch T, Salinas F, et al. Anatomic basis to the ultrasound-guided approach for saphenous nerve blockade. Reg Anesth Pain Med 2009;34(5):486–489. DOI: 10.1097/AAP.0b013e3181ae11af.
Kapoor R, Adhikary SD, Siefring C, et al. The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal: an anatomical study. Acta Anaesthesiol Scand 2012;56(3):365–367. DOI: 10.1111/j.1399-6576.2011.02645.x.
Jaeger P, Nielsen ZJ, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013;118(2):409–415. DOI: 10.1097/ALN.0b013e318279fa0b.
Jenstrup MT, Jaeger P, Lund J, et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 2012;56(3):357–364. DOI: 10.1111/j.1399-6576.2011.02621.x.
Kirkpatrick JD, Sites BD, Antonakakis JG. Preliminary experience with a new approach to performing an ultrasound-guided saphenous nerve block in the mid to proximal femur. Reg Anesth Pain Med 2010;35(2):222–223. DOI: 10.1097/AAP.0b013e3181d24589.
Schoenmakers KP, Wegener JT, Stienstra R. Effect of local anaesthetic volume (15 vs 40 mL) on the duration of ultrasound-guided single shot axillary brachial plexus block: a prospective randomized, observer-blinded trial. Reg Anaesth Pain Med 2012;37(3):242–247. DOI: 10.1097/AAP.0b013e3182405df9.
Scott DB, Lee A, Fagan D, et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anaesth Analg 1989;69(5):563–569. DOI: 10.1213/00000539-198911000-00003.
Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2017;118(2):167–181. DOI: 10.1093/bja/aew411.
Aboelela M, Kandeel AR, Elsayed U, et al. Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: a prospective randomized controlled study. Saudi J Anaesth 2018;12(2):297–303. DOI: 10.4103/sja.SJA_577_17.
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. Anaesthesiology 2011;115(4):836–843. DOI: 10.1097/ALN.0b013e318221fcc9.
Lanqvist PA. Alpha-2 adrenoceptor agonists as adjuncts to peripheral nerve blocks in children–is there a mechanism of action and should we use them? Paediatr Anaesth 2012;22(5):421–424. DOI: 10.1111/j.1460-9592.2012.03821.x.
Keplinger M, Marhofer P, Kettner SC, et al. A pharmacodynamic evaluation of dexmedetomidine as an additive drug to ropivacaine for peripheral nerve blockade: a randomised, triple-blind, controlled study in volunteers. Eur J Anaesthesiol 2015;32(11):790–796. DOI: 10.1097/EJA.0000000000000246.
Andersen JH, Grevstad U, Siegel H, et al. Does dexmedetomidine have a perineural mechanism of action when used as an adjuvant to ropivacaine? A paired, blinded, randomized trial in healthy volunteers. Anaesthesiology 2017;126(1):66–73. DOI: 10.1097/ALN.0000000000001429.
Goyal R, Mittal G, Yadav AK, et al. Adductor canal block for postoperative analgesia after simultaneous bilateral total knee replacement: a randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine. Indian J Anaesth 2017;61(11):903–909. DOI: 10.4103/ija.IJA_277_17.
Rajkhowa T, Das N, Parua S. Fentanyl as an adjuvant for brachial plexus block: a randomized comparative study. Int J Clin Trials 2016;3:64–67. DOI: 10.18203/2349-3259.ijct20160996.
Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block: a randomized controlled trial. Anesth Analg 2015;121(6):1655–1660. DOI: 10.1213/ANE.0000000000001006.
Farooq N, Singh RB, Sarkar A, et al. To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvant to ropivacaine in brachial plexus block: a double-blind, prospective, randomized study. Anesth Essays Res 2017;11(3):730–739. DOI: 10.4103/aer.AER_30_17.