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Total knee arthroplasty under quadruple nerve block with ropivacaine 0.32%: effect of addition of intravenous dexmedetomidine to intravenous dexamethasone on analgesic duration
  1. Clement Chassery1,
  2. Philippe Marty1,
  3. Olivier Rontes1,
  4. Martine Chaubard1,
  5. Corine Vuillaume1,
  6. Bertrand Basset1,
  7. Mehdi Merouani1,
  8. Constance Marquis1,
  9. Anne De Lussy1,
  10. Marie-Claude Delbos1,
  11. Julie Casalprim1,
  12. Benoit Bataille2,
  13. Cecile Naudin3,
  14. Fabrice Ferre4 and
  15. Alain Delbos1
  1. 1Anesthesia, Clinique Medipole Garonne, Toulouse, France
  2. 2Department of Anesthesia and Intensive Care, Narbonne general Hospital, Narbonne, France
  3. 3Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France
  4. 4Department of Anesthesia, CHU Purpan, Toulouse, France
  1. Correspondence to Dr Philippe Marty, Anesthesia, Clinique Medipole Garonne, 31036 Toulouse, France; philippemarty{at}hotmail.com

Abstract

Background and objectives Peripheral nerve blocks reduce postoperative pain and enhance recovery after total knee arthroplasty (TKA). This study aims to assess the benefits of addition of intravenous dexmedetomidine (DexM) to intravenous dexamethasone on the analgesic duration of quadruple nerve blocks.

Methods This double-blind, randomized, controlled trial prospectively enrolled 90 patients scheduled for TKA under quadruple nerve blocks (sciatic, femoral, obturator, and lateral femoral cutaneous nerves blocks) with 70 mL, 0.32% ropivacaine. All patients received systemic dexamethasone 10 mg. Patients were randomized to receive DexM (2 µg/kg, intravenous) or placebo (1:1 ratio). The primary endpoint was the duration of analgesia defined as the time to first request for rescue analgesia (oxycodone).

Results Kaplan-Meier curves for the first analgesic request were similar between groups (log-rank test; p=0.27). Median (IQR) duration of analgesia was similar between placebo (1575 min (1211–1952)) and DexM (1470 min (1263–1700)) groups (p=0.56). Cumulative consumption of oxycodone at the 48th hour was 20 mg (10–30) and 30 mg (20–40) in placebo and DexM groups, respectively (p=0.14). The day after surgery, 93% and 89% of patients were able to walk in placebo and DexM groups, respectively (p=0.46). Intravenous DexM was associated with bradycardia, hypotension and longer recovery room stay (p<0.05 for all comparisons).

Conclusions In a multimodal analgesic regimen, addition of systemic DexM (2 µg/kg) to systemic dexamethasone does not prolong the analgesic duration of quadruple nerve block with ropivacaine 0.32% after TKA.

Trial registration number NCT03834129.

  • analgesia
  • nerve block
  • pain
  • postoperative
  • pain management
  • lower extremity
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Footnotes

  • Contributors Study design/planning: CC, PM, AD. Collecting the data: BB, JC, CC, MC, AD, ADL, CM, PM, MM, OR, CV, M-CD. Data analysis: CN. Writing, drafting, and revision of the paper: CC, PM, FF, BB, AD.

  • Funding This work should be attributed to the Department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France. Support was provided solely from institutional and department sources from the department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Oversight and study approval were provided by the Committee for Protection of Human Subjects (CPPIDF1-2018-ND80 cat.1) on November 13, 2018.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request at philippemarty@hotmail.com.

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