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BJA Advance Access published online on June 20, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen184
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery

R. R. Al-Metwalli, H. A. Mowafi*, S. A. Ismail, A. K. Siddiqui, A. M. Al-Ghamdi, M. A. Shafi and A.-R. El-Saleh

Department of Anaesthesia, Faculty of Medicine, King Faisal University, Saudi Arabia

* Corresponding author: Department of Anaesthesiology, King Fahd University Hospital, PO Box 40081, Al-Khobar 31952, Saudi Arabia. E-mail: hany_mowafi{at}hotmail.com, hany.mowafi{at}gmail.com

Background: Alpha-2-adrenergic agonists have peripheral analgesic effects. We have assessed the potential analgesic effect of dexmedetomidine after intra-articular administration in arthroscopic knee surgery.

Methods: Sixty patients undergoing arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The control group received i.v. and intra-articular saline, the intra-articular group received i.v. saline and intra-articular dexmedetomidine, and the i.v. group received i.v. dexmedetomidine and intra-articular saline. Haemodynamic changes, pain visual analogue scale (VAS), sedation score, the time to first postoperative analgesic request, and the total postoperative analgesic use during the first 24 h were evaluated.

Results: Dexmedetomidine administration resulted in a significant reduction in pain scores for 6 h after operation in the intra-articular group but only for 1 h in the i.v. group. The time to first postoperative analgesic request was longer in the intra-articular group [312.0 (SD 120.7) min] compared with the control group [71.0 (50.1) min] and the i.v. group [102.1 (54.4) min] (P<0.001). Total diclofenac requirement was significantly lower in the intra-articular group [90.0 (46.2) mg] than in the control group [165.0 (52.2) mg] and in the i.v. group [129.3 (54.3) mg] (P<0.05).

Conclusions: Intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery, with an increased time to first analgesic request and a decreased need for postoperative analgesia.

Keywords: analgesia, postoperative; analgesic techniques, intra-articular; analgesics non-opioid, diclofenac; surgery, orthopaedic; sympathetic nervous system, dexmedetomidine


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