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Pain Management for anterior cruciate ligament reconstructionOnly 14 pages are availabe for public view
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Abstract
The safety and efficacy of regional anesthesia for patient’s undergoing lower extremities surgeries has been established. Regional anesthesia is preferred since it allows patients to be awake and avoiding the risks of general anesthesia, but one of the limitations of spinal anesthesia is the relatively short duration of post-operative analgesia. In recent years, several drugs e.g.: opioids, benzodiazepines, α2 agonists, NMDA-receptor antagonist and neostigmine have been used. intrathecally as adjuvants anesthetics to local with the aim of prolonging the duration of block, better success rate and patient satisfaction. The present study included sixty patients scheduled for elective ACL reconstruction at Mansoura university students’ hospital were randomly allocated into three equal groups:group C (n=20): They received 3 ml of 0.5% hyperbaric Bupivacaine (15mg) + 1 ml normal saline, both in the same syringe. group D1 (n=20): They received 3 ml of 0.5% hyperbaric Bupivacaine (15mg) + 10 µg dexmedetomidine diluted to 1 ml with normal saline, both in the same syringe. group D2 (n=20):They received 3 ml of 0.5% hyperbaric Bupivacaine (15mg) + 20 µg dexmedetomidine diluted to 1 ml with normal saline, both in the same syringe. Our results revealed that there was no difference among the three studied groups in the time to reach T10 dermatomal sensory block. Highest level of sensory block achieved was T9 dermatome in group C, T8 dermatome in group D1 and T6 dermatome in group D2 . Time of sensory regression to S1 dermatome showed a statistically significant increase in group D2 more than group D1 more than group C. Time of motor block to reach Bromage 3 showed a statistically significant decrease in group D2 as compared with group C.Time of motor block regression to Bromage 0 showed a statistically significant increase in group D2 more than group D1 more than group C.Mean arterial blood pressure showed a statistically significant decrease in group D2 more than group D1 more than group C from 10 minutes up to 3 hours postspinal. Heart rate showed a statistically significant decrease in group D2 more than group D1 more than group C from 15 minutes up to 3 hours postspinal.
Pain was assessed by VAS that showed it was zero until 3 hours postspinal in group C , 6 hours postspinal in group D1 and 12 hours postspinal in group D2. In conclusion, the present study demonstrates that Addition of different doses dexmedetomidine intrathecally to hyperbaric bupivacaine prolongs the duration of sensory and motor block with more postoperative analgesia in a dose-dependent manner compared to bupivacaine alone. Hemodynamic changes (hypotension & bradycardia) and urine retention were more pronounced in group Dexmedetomidine 2 more than group Dexmedetomidine 1 more than group Controlled at most time points of the study. Hypotension and bradycardia extended to maximum at 6 hours postspinal.