الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Knee arthroscopy is a surgical procedure that is commonly performed on a day-case basis. However, it’s usually associated with a variable amount of pain, the incidence of moderate-to-severe pain is about 70% postoperative. Inadequately treated postoperative pain results in delayed recovery, prolonged hospitalization, and increased medical care costs. The use of intrathecal opioids, such as fentanyl or morphine, provides excellent postoperative analgesia but could cause side effects such as urinary retention, pruritus, nausea, and vomiting, which leads to a prolonged hospital stay. Anti-inflammatory drugs can provide good analgesia in the immediate postoperative period. However, they are not site-specific and usually have side effects such as acute gastric lesions.
Regional nerve block offers an alternative choice of anesthesia using minimal anesthetic drugs with a high safety profile. Bupivacaine is used frequently for nerve block as it has a long duration of action from 6 to 9 h. Different adjuvants have been used to prolong regional Blockade, shorten the onset times of blocks and prolong duration of post operative analgesia.
In our study we explored the different adjuvant effects of adding dexmedetomidine and/or dexamethasone to bupivacaine while using facsia iliaca block for knee arthroscopy and their efficacy in achieving better postoperative analgesia.
We recruited 45 patients, for which all underwent routine preoperative laboratory investigations as (complete blood picture, bleeding time, prothrombin time, partial thromboplastin time, Kidney function, Liver functions and viral markers) as well as imaging investigations as plain chest x-ray. They were then assigned into one of three equal groups: group A (38 mL 0.25% bupivacaine +2 mL normal saline); group B (38 mL of bupivacaine 0.25% +2 mL of dexamethasone 8mg) and group C (38 mL of bupivacaine 0.25% +2 mL of dexmedetomidine with dose 0.5 µg/kg),
Monitoring of Systolic blood pressure, Diastolic blood pressure, heart rate, electrocardiography and pulse oximetry readings were done. Duration of postoperative analgesia using VAS and NAS scores for assessment and patient satisfaction score at the end of the study were obtained. Assessment of any side effects in the form of bradycardia, hypotension, sedation associated with the drugs used was recorded.
Our study showed that using dexamethasone and/or dexmedetomidine as adjuvant to bupivacaine in fascia iliaca block significantly prolonged its effect, decreased post-operative pain and need of IV analgesic.
We also found that using dexmedetomidine prolonged the effects of bupivacaine more than dexamethasone, and patient sedation was more frequent with dexmedetomidine group.
In our study there was a decrease mean of heart rate in the three groups over the periods, but the decrease was more evident in group B and group C in comparison to group A (p-value <0.05).
During follow up of all patients following administration of FICB the presence of complications among the three groups was not significantly different and occurred in the first hour but was not observed again, bradycardia was most evident group C. No patients experienced nausea, vomiting or airway compromise or required airway assistance because of sedation. And there were no recorded complications related to the block techniques or to the drugs.
RECOMMENDATIONS & CONCLUSION
Our study shows that adding Dexmedetomidine and/or Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures.
In conclusion, we recommend doing further studies on a larger group of patients to better document our findings. using different doses of the adjuvant medications should also be studied. Finally, we would like to recommend studying the use of these adjuvants in FICB for other indicated interventions as well as in other regional nerve blocks.