Diab Doaa Galal, Elmaddawy Alaaeldin Adel, Elganainy Abdelrahman
Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Orthopedic, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Anesth Essays Res. 2019 Jan-Mar;13(1):7-12. doi: 10.4103/aer.AER_154_18.
Knee arthroscopy has both diagnostic and therapeutic applications which can be performed under general, regional, or local anesthesia. Morphine is used as an additive to local anesthetics. Dexmedetomedine, the highly selective alpha-2 (α2)-adrenoceptor agonist with the sedative and analgesic effect can be used also to augment local anesthetic effect.
Sixty patients submitted for elective knee arthroscopy whose age between 25 and 45 years, of either sex, the American society of anethesiologists physical status Classes I and II at a university hospital were enrolled in this study. Patients were classified into two groups. Morphine Group (M) ( = 30): Patients received 20 ml of 0.5% bupivacaine plus 5 ml of 0.2% lidocaine with epinephrine 1:200,000 plus 1 mg morphine. Dexmedetomedine Group (D) ( = 30): Patients received 20 ml of 0.5% bupivacaine plus 5 ml of 0.2% lidocaine with epinephrine 1:200,000 plus 1 μg/kg dexmedetomedine.
Demographic data of patients showed no significant difference among the studied groups. Heart rate (HR) was significantly lower in (D) Group compared to that of (M) Group 5 min from the start of procedure to immediately postoperatively. Moreover, (D) Group showed a significant decrease in HR 10 min up to 35 min intraoperatively compared to the basal value. Furthermore, mean arterial blood pressure (MBP) was significantly lower in (D) Group compared to that of (M) Group 15 min from the start of surgery up to 1 h postoperatively. Furthermore, (D) Group showed a significant decrease in MBP 15 min intraoperative up to 2 h postoperatively compared to the basal value. While there was no significant difference in (visual analogue score [VAS], onset and total consumption of ketorolac, surgeon and patients' satisfaction, side effects in (D) Group compared to (M) Group, respectively.
Addition of either morphine or dexmedetomidine to bupivacaine intraarticularly improved both intraoperative anesthesia and postoperative analgesia with minimal side effects or complications in knee arthroscopy, with superiority of dexmedetomidine compared to morphine on hemodynamic stability.
膝关节镜检查具有诊断和治疗作用，可在全身麻醉、区域麻醉或局部麻醉下进行。吗啡用作局部麻醉剂的添加剂。右美托咪定是一种具有镇静和镇痛作用的高选择性α2肾上腺素能受体激动剂，也可用于增强局部麻醉效果。
本研究纳入了一所大学医院的60例择期膝关节镜检查患者，年龄在25至45岁之间，性别不限，美国麻醉医师协会身体状况分级为I级和II级。患者分为两组。吗啡组（M组）（n = 30）：患者接受20 ml 0.5%布比卡因加5 ml 0.2%利多卡因加肾上腺素1:200,000再加1 mg吗啡。右美托咪定组（D组）（n = 30）：患者接受20 ml 0.5%布比卡因加5 ml 0.2%利多卡因加肾上腺素1:200,000再加1 μg/kg右美托咪定。
患者的人口统计学数据在各研究组之间无显著差异。从手术开始至术后即刻5分钟，D组的心率（HR）显著低于M组。此外，与基础值相比，D组在术中10分钟至35分钟时HR显著降低。此外，从手术开始15分钟至术后1小时，D组的平均动脉血压（MBP）显著低于M组。此外，与基础值相比，D组在术中15分钟至术后2小时MBP显著降低。而D组与M组相比，视觉模拟评分（VAS）、酮咯酸的起效时间和总用量、外科医生和患者的满意度、副作用方面均无显著差异。
在膝关节镜检查中，关节腔内将吗啡或右美托咪定添加到布比卡因中均可改善术中麻醉和术后镇痛，且副作用或并发症最小，与吗啡相比，右美托咪定在血流动力学稳定性方面更具优势。
