Analgesic efficacy of single- shot adductor canal block with levobupivacaine and dexmedetomidine in total knee arthroplasty: A randomized clinical trial

Abstract

ABSTRACTBackground The goal of this study was to compare the analgesic efficacy of dexmedetomidine and levobupivacaine in adductor canal block (ACB) in total knee arthroplasty (TKA) patients, as well as the ambulation ability and adverse effects.Methods Sixty patients, ranging in age from 18 to 60 years old and with an ASA status of I to II, had unilateral TKA under spinal anesthesia. They were randomized into two groups; Group L received 20 mL of 0.25% levobupivacaine and Group LD received 20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine for ACB. The time it took for the first analgesic to be requested, the amount of morphine used in a 24-hour period, the postoperative pain score, and the range of motion (ROM), a 100-foot walking test data, sedation, patient satisfaction, and adverse outcomes were measured.Results LD group had lower scores of VAS either at rest or on movement at nearly all-time intervals. The mean time to first analgesic request in group L (406.77 ± 10.64 min) and group LD (515.10 ± 27.98 min, P-value <0.001). The mean total dose of morphine consumed in first 24 h postoperative was significantly lower in LD group (6.47 ± 2.01 mg) when compared to L group (10.93 ± 2.35 mg, P value <0.001). There were significant differences in ROM test, 100 foot test, and patient satisfaction between groups but no major adverse effects in both groups.Conclusion The addition of 0.5 µg/kg dexmedetomidine to 20 mL of 0.25% levobupivacaine in single-shot ACB is better than 20 mL of 0.25% levobupivacaine alone regarding postoperative analgesia, patient satisfaction and ambulation ability following TKA but, with low rate of adverse events in both groups.

Keywords

• Adductor canal block
• levobupivacaine
• dexmedetomidine
• total knee arthroplasty
• range of motion
• 100 foot test