الفهرس 
ANATOMICAL CONSIDERATIONOnly 14 pages are availabe for public view
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Abstract
T
he present study aimed to test the efficacy of adding 100 μg dexmedetomidine to levobupivacaine on duration and quality of intraoperative anaesthesia and postoperative analgesia for patients undergoing total knee replacement using ultrasound-guided femoral–sciatic nerve block.
After ethical approval, 60 patients aged 45-65 years old, with an American Society of Anaesthesiologists (ASA) physical class from I to II who underwent total knee surgery using combined femoral-sciatic anaesthesia, were included in this prospective, randomized, double-blinded study.
Patients were randomly assigned to receive levobupivacaine alone (group B) or dexmedetomidine 100 μg added to bupivacaine (group BD) [n = 30 for each group] for combined femoral–sciatic nerve block
Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR), systolic arterial blood (BP) also monitored.
This study showed that the addition of dexmedetomidine 100 μg to levobupivacaine during ultrasound-guided combined femoral-sciatic nerve block for below knee surgery was associated with +50 % longer duration of analgesia, -20% shorter onset times for sensory and motor block, -25% faster time for surgical readiness, and longer duration of sensory and motor block (+45% and +40%, respectively).
Unfortunately, the present study found that the addition of 100 μg dexmedetomidine to bupivacaine during femoral–sciatic nerve block for below knee surgery was associated with bradycardia and hypotension (30% and 10 %, respectively).
As for complications, there has been recent emphasis on risk of falls linked to peripheral nerve blocks. In our study, FNB increased the risk of falls post TKA. Several studies have reported that FNB results in weakness of all four components of the quadriceps muscle increasing fall risks.
We recommend that, after having a FNB, patients should undergo enhanced postoperative evaluation of blockade and proprioceptive function (in particular 2-point discrimination, light touch, and vibration sense) to ensure safe neurological function before mobilisation.