Ultrasound-guided H-FICB for Arthroscopic Knee Surgery： What is the Optimal Dose of Dexmedetomidine?
Condition: Knee Disease; Quality of Recovery
Study type: Interventional

Summary: 
      Total knee replacement (TKR) is among the most commonly performed orthopedic procedures, and
      a six-fold increase in the number of TKR cases world-wide is projected within a decade as the
      aging of the populations . As the number of the TKR procedures increases, various approaches
      increasing the satisfaction and comfort of the patient and the surgeon are of interest in
      order to provide improved pain management, in-hospital stay, and recovery with the
      development of modern anesthesiology and pain management techniques.This study aimed to
      investigate the clinical effect of ultrasound-guided high fascia iliaca compartment
      block(H-FICB) in patients undergoing knee arthroscopy and to compare it with the normal
      method which is femoral nerve block combined with a sciatic nerve block to choose the better
      way. A double-blind, randomized controlled trial was conducted with 44 patients, aged 18-65
      years, ASA I-III, who were scheduled to undergo arthroscopic knee surgery in our hospital
      were selected, the patients were divided into Group A and Group B by random number table
      method, with 22 patients in each group. Group A was subjected to the H-FICB under ultrasound
      guidance before general anesthesia, given 0.375% ropivacaine+0.5ug/kg Dexmedetomidine 30 ml.
      Group B was subjected to the H-FICB under ultrasound guidance before general anesthesia,
      given 0.375% ropivacaine+1ug/kg Dexmedetomidine 30 ml.

      The mini-mental State Examination was used to assess all the patients' primary cognitive
      status one day before surgery. The initial acting time and the degrees of sensory block and
      motor block were recorded after the nerve block was completed. Perioperative variables were
      recorded to be compared. The investigators used the visual analog scale to assess patients'
      pain degree with postoperative, recorded the occurrence of adverse events such as
      postoperative nausea and vomiting(PONV), delayed emergence from anesthesia, and respiratory
      depression. The confusion assessment method was used to assess whether patients experienced
      delirium.
    

Detailed description: 
      1. Study design and setting 44 patients undergoing arthroscopic knee surgery under general
           anesthesia, gender, aged 18-65 years, American Society of Anesthesiologists (ASA)
           physical status I-III. Exclusion criteria: communication and dysfunction (e.g., vision,
           hearing), cerebrovascular history, local anesthetic allergy, opioid allergy, puncture
           site infection, abnormal clotting.

        2. Subjects Patients were allocated randomly to A group (the Modified Fascia Iliaca
           Compartment block+0.5ug/kg Dexmedetomidine ) and B group (tthe Modified Fascia Iliaca
           Compartment block+1ug/kg Dexmedetomidine) according to a computer-generated random
           number table. All patients and an investigator who was responsible for follow-up during
           48 postoperative hours were blinded to the randomization groups. In addition, during
           preoperative visits, the investigators instructed patients on how to use the
           patient-controlled intravenous analgesia (PCA) device for pain management, as well as
           how to use the visual analog scale to evaluate pain at rest and while coughing. All the
           bispectral index (BIS) value in the present study was maintained between 40 and 60
           during surgery. All patients voluntarily signed informed consent.

        3. General anesthesia Patients were monitored by electrocardiogram, pulse oximetry, and
           non-invasive blood pressure (one measurement every 3 min) while entering the operation
           room. A radial artery catheter was also placed for invasive arterial pressure and blood
           gas monitoring. The induction of general anesthesia was performed intravenously with
           sufentanil 0.5 µg/kg, propofol 1-2 mg/kg, and rocuronium 0.6 mg/kg. Endotracheal
           intubation was performed with a double-lumen tube. Sevoflurane was used at a minimal
           alveolar concentration (MAC) of 0.8-1, remifentanil and propofol were used for the
           maintenance. Fluid management was at the discretion of the attending anaesthesiologist.
    

Intervention name(s): ultrasound-guided high fascia iliaca compartment block
Intervention type(s): Procedure
Intervention description(s): H-FICB was guided by ultrasound before general anesthesia. The patient was supine. First, the probe is placed transversely above the groin. Then slide the probe up and down to reveal a clear image of the internal oblique and sartorius muscles. There is a bowtie-like iliac fascia space at the junction of these two muscles. After the scanning, the needle was inserted behind the probe with the tip pointed to the ventral side under the guidance of real-time ultrasound; the tip passed through the skin into the iliac fascia space and advanced to the inguinal ligament. After no blood was extracted, 1 ~ 2 ml of normal saline was firstly injected to determine whether the tip position was correct.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: modified fascia iliaca compartment block; visual analogue scale(VAS) score