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Arthroscopic knee surgery is a surgical procedure that can diagnose and treat problems in the knee joint.
Intra-articular administration of dexmedetomidine (DEX)
improved pain outcomes in the early postoperative period after knee arthroscopy
Arthroscopic knee surgery is a surgical procedure that can
diagnose and treat problems in the knee joint. Patients with knee pain are
managed on a day-case basis; therefore, appropriate postoperative pain relief
is critical to facilitate patient discharge and early recovery. A simple method
to treat knee joint pain providing prolonged duration of action, and minimal
adverse effects is in demand.
It was well reported in the previous studies that systemic
administration of DEX produces sedative, analgesic, sympatholytic, and
anesthetic-sparing effects. It was also suggested that DEX alone or in
combination with already marketed anesthetics drugs significantly reduce the
postoperative pain without any adverse events. A study conducted on the
combination of DEX and local anesthetic agent demonstrate this an ideal
combination for relief of pain after knee arthroscopy.
A critical literature search found no published
meta-analysis investigating the effects of intra-articular administration of
DEX on postoperative pain after arthroscopic knee procedures. Therefore, the
present study was conducted to determine the benefits and adverse effects of
intra-articular administration of DEX in arthroscopic knee surgery.
Rationale behind the research:
To the author’s knowledge, there are no published
meta-analyses investigating the effects of DEX on postoperative pain after
arthroscopic knee procedures.
Therefore, the author designed this research to determine the
effect of DEX on the postoperative pain after knee surgery.
Objective:
To evaluate the analgesic effects of intra-articular (DEX in
arthroscopic knee surgery.
Study outcome measures:
Quality assessment:
The methodological quality was assessed with the Cochrane risk of bias tool.
The quality of evidence for each outcome measure was evaluated with Grading of
Recommendations Assessment, Development and Evaluation (GRADE) methodology.
Time period: At rest, 1, 2, 4, 6, 8, 12, and 24 h
Study Outcomes:
This meta-analysis revealed that intra-articular DEX
significantly decreases postoperative pain and opioid consumption. The findings
of this study also established the prolonged analgesic effect of DEX.
Concerning the secondary outcomes, no difference was found in the incidence of
PONV, hypotension, or bradycardia between the DEX and control groups.
The previous study conducted by Al-Metwalli et al. had
shown that patients treated with intra-articular and intra venous saline
reported pain intensity of 5 points on a VAS up to 12 h postoperatively. That
resulted in delayed patient discharge and postoperative rehabilitation. Due to
the adverse effects associated with systemic opioid use, administration of
intra-articular analgesia is simple and may provide a better alternative.
In this meta-analysis, DEX treatment decreased VAS pain
scores by 1.57 points at rest and 1.71 points on movement at postoperative 1 h.
At 24 h the postoperative pain was more dropped to 0.34 points, but the
difference remained significant.
The mechanism underlying the effects of intra-articular DEX
is unknown. A recent study has demonstrated that combination of clonidine and
DEX prolonged sensory and motor blockade by local anesthetics. Similar to
clonidine, it was reported that DEX acts on presynaptic receptors and inhibits
the release of norepinephrine at peripheral afferent nociceptors. Some of the
studies also suggest that DEX acts by direct inhibition of
tetrodotoxin-resistant sodium (Na+) channels may contribute to the
antinociceptive effects of clonidine and DEX when used in addition to local
anesthesia. Another study indicated that DEX inhibited neuronal
delayed-rectifier potassium currents and sodium currents to produce local
anesthetic effects.
In this meta-analysis, intra-articular DEX did not increase the incidence of hypotension or bradycardia compared to that in the control group. The low incidence of adverse effects may be related to the lack of vessels in the articular surface, and the relatively small dose of DEX administered.
In conclusion, intra-articular
administration of DEX improved pain outcomes in the early postoperative period
after knee arthroscopy.
Intra-articular administration of DEX can improve pain
outcomes in the early postoperative period after the knee arthroscopy.
Sci Rep. 2018 Mar 6;8(1):4089.
Intra-articular dexmedetomidine in knee arthroscopy: A systematic review and meta-analysis
Ke Pang et al.
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