Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
BMC Anesthesiol. 2023 Dec 6;23(1):400. doi: 10.1186/s12871-023-02361-0.
Total knee arthroplasty (TKA) is a common orthopedic procedure for end-stage knee osteoarthritis. Although effective in relieving pain and improving function, postoperative pain is still a common and distressing problem for many patients. This study aims to investigate efficacy of combined administration of dexmedetomidine and modified high fascia iliaca compartment block (H-FICB) in managing acute and chronic pain after TKA, as well as to identify the optimal dosage of dexmedetomidine.
A double-blind, randomized controlled trial was conducted to evaluate the effects of dexmedetomidine in patients undergoing TKA. A total of 96 patients undergoing TKA were randomly assigned to one of three groups, were treated with different doses of dexmedetomidine All groups received H-FIB. Pain scores, opioid consumption, side effects, and quality of life were recorded 48 h postoperatively.
The intraoperative consumption of remifentanil and propofol in Group D was significantly reduced compared with that in Group D and D (P < 0.05). Compared with D and D group, D group had the lowest number of rescue analgesia, analgesia time and morphine accumulative dosage 48 h after operation (P < 0.05). The D group had the lowest scores on the numerical rating scale at rest (P < 0.05) and during movement (P < 0.01), followed by the D group and then the D group. Additionally, the incidence of nausea and vomiting was significantly reduced in the D group (P < 0.05). Furthermore, the D group had the lowest incidence of chronic pain (P < 0.05).
In comparison to the other two groups, the administration of combined dexmedetomidine and H-FIB resulted in a significant reduction in pain scores, opioid consumption, and side effects. The optimal dosage of dexmedetomidine was determined to be 1 μg/kg, which provided the most favorable pain relief with minimal adverse effects.
全膝关节置换术（TKA）是治疗膝关节晚期骨关节炎的常见骨科手术。尽管它可以有效缓解疼痛和改善功能，但术后疼痛仍然是许多患者常见且令人痛苦的问题。本研究旨在探讨右美托咪定联合改良高位股筋膜间隙阻滞（H-FICB）在管理 TKA 后急性和慢性疼痛方面的疗效，并确定右美托咪定的最佳剂量。
采用双盲、随机对照试验评估 TKA 患者右美托咪定的效果。96 例行 TKA 的患者随机分为三组，分别接受不同剂量的右美托咪定，三组均接受 H-FIB。记录术后 48 小时的疼痛评分、阿片类药物用量、不良反应和生活质量。
与 D 组和 D 组相比，D 组术中瑞芬太尼和丙泊酚的用量明显减少（P<0.05）。与 D 组和 D 组相比，D 组术后 48 小时内的补救性镇痛次数、镇痛时间和吗啡累积剂量最低（P<0.05）。D 组静息时（P<0.05）和运动时（P<0.01）的数字评分量表评分最低，其次是 D 组，然后是 D 组。此外，D 组恶心呕吐的发生率明显降低（P<0.05）。此外，D 组慢性疼痛的发生率最低（P<0.05）。
与其他两组相比，右美托咪定联合 H-FIB 可显著降低疼痛评分、阿片类药物用量和不良反应。右美托咪定的最佳剂量为 1μg/kg，其具有最小的不良反应，提供了最佳的镇痛效果。
