Supervisors info:
Γκιόκας Γεώργιος, Αναπληρωτής Καθηγητής, Ιατρικής Σχολή, ΕΚΠΑ.
Ξάνθος Θεόδωρος, Καθηγητής, Ευρωπαϊκό Πανεπιστήμιο Κύπρου.
Χαλκιάς Αθανάσιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, Πανεπιστήμιο Θεσσαλίας.
Summary:
Intoduction: A lot of adjuvants (eg. morphine, fentanyl, clonidine, ketamine) have been used in anaesthetic practice, for improvement of perioperative analgesia following spinal anaesthesia. Nevertheless, each adjuvant has its associated side-effects. Thus, research for an effective adjuvant pursues. Recently, dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist, is being studied as an adjuvant in intrathecal anesthesia.
Aims: Our study aims to examineand compare the efficacy and safety of intrathecal dexdemetomidine as an adjuvant in spinal anaesthesia and intravenous administration with continuous infusion, coupled with intrathecal anesthesia, in Total Knee Arthroplasty (TKA) procedures.
Methods: It was a double-blind, prospective study among 60 patients undergoing TKA under spinal anaesthesia distributed in three groups: Control Group received 3 ml of levobupivacaine 0,5% (15 mg) + 0,5 ml N/S 0,9 %, intrathecally. DEXSub group received 3 ml levobupivacaine 0,5 % (15 mg) + dexmedetomidine (5g) + N/S 0,9 %, intathecally and DEXIV group received 3 ml levobupivacaine 0,5 % (15 mg) + 0,5 ml N/S 0,9 %, intrathecally and dexmedetomidine i.v, with a loading dose (1γ/kg) and then in continuous infusion (0,25γ/kg/hr). Onset and duration of sensory and motor block, postoperative analgesia duration and intraoperative arterial pressure and heart rate were recorded.
Results: The DEXIV group had faster onset of sensory block (p<0,005). DEXSub group presented with longer duration of sensory and motor block (p<0,005). Both DEX groups presented with longer duration of analgesia (p<0,005). The DEXSub group had the longest duration of postoperative analgesia, most effective for the 3 first hour post-operatively (p<0,005). All patients presented hemodynamic stability. No adverse effects were recorded.
Conclusions: The present study not only proves dexmedetomidine’s efficacy with regard to post-operative analgesia but also its safety in intrathecal and i.v administration, as an adjuvant in TKA. It would be interesting to study the combination of i.v dexmedetomidine’s administration with other adjuvants intrathecally, as part of an effective multimodal strategy.
Keywords:
Dexmedetomidine, Total knee arthroplasty, Analgesia, Regional anesthesia
