Comparison of Intra-articular Dexmedetomidine and Magnesium in Postoperative Pain
Condition: Postoperative Pain; Intra-articular Injection; Dexmedetomidine; Magnesium Sulfate
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      Arthroscopic meniscus surgeries are the most frequent orthopedic procedures. The objective of
      the study is to compare the effects of intraarticular local anesthetic and adjuvant
      (dexmedetomidine vs magnesium) combinations in postoperative pain and analgesic requirement.
      The investigators' hypothesis is adjuvants added to the local anesthetics decreases the total
      local anesthetic dose, provides more effective pain relief according to local anesthetic
      only, and decreases the postoperative systemic non-steroidal analgesic and opioid doses.
    

Detailed description: 
      Arthroscopic meniscus surgeries are the most frequent orthopedic procedures. However,
      irritation of free nerve endings in the synovial tissue and anterior fat pads and stretching
      and resection in the joint capsule lead to pain at various levels. Proper pain management
      enhances recovery, provides early mobilization and shortens length of hospital stay.

      "Opioid-free" analgesia methods are frequently emphasized in published postoperative pain
      management guidelines and multimodal treatment approaches such as local anesthetic
      infiltration is recommended. In the treatment of knee pain, intra-articular drug injections
      are the most commonly used method because of minimal systemic side effects.

      The drugs most commonly administered intraarticularly included local anesthetics
      (bupivacaine, levobupivacaine, lidocaine), opioids (morphine, fentanyl), magnesium sulfate,
      steroids, and α2 agonists (clonidine, dexmedetomidine).

      Dexmedetomidine is a selective, specific, lipophilic and potent α2 adrenergic receptor
      agonist with sedative, anxiolytic, analgesic, antihypertensive and sympatholytic effects. It
      provides analgesic activity through both the central and peripheral nervous system. The
      analgesic effects of intra-articular administration of dexmedetomidine in arthroscopic
      surgeries have been demonstrated. Most side effects of this drug included hypotension and
      bradycardia. However, these side effects have never been encountered with intra-articular
      injection of the drug.

      Magnesium is also an adjuvant drug which has a key role in nociceptive transmission, and acts
      as a NMDA (N-Methyl-D-Aspartate) antagonist in spinal neurons.

      While opioid free anesthesia and analgesia methods gain importance nowadays, there has been
      increased interest in non-opioid analgesic drugs and multimodal analgesia applications. In
      order to increase the effects of local anesthetics and prolong their analgesic times, the
      addition of various adjuvants to local anesthetics is frequently used.

      In the randomized controlled trials, intraarticular local anesthetic drugs combined with
      adjuvant drugs for postoperative analgesia were found to be superior to local anesthetic
      drugs alone. It is also known that local anesthetics have negative effects on chondrocytes.
      One of the goals of the investigators' in this study is to reduce the amount of local
      anesthetic used by adding adjuvant to local anesthetics.

      In this study, the investigators plan to compare the efficacy of 2 adjuvants (magnesium
      sulfate and dexmedetomidine) combined with local anesthetics to be given intraarticularly for
      postoperative pain management after elective arthroscopic surgery.

      Intraarticular high-volume drug injections may cause pain due to tension in the joint
      capsule. Additionally, the investigators aim to decrease the total drug volume with adjuvant
      drugs used in combination with local anesthetic, and thus to prevent joint capsule tension
      pain.
    

Intervention name(s): Precedex; Magnesium Sulfate
Intervention type(s): Drug; Drug
Intervention description(s): 10 ml of Bupivacaine ve 50mcg Dexmetedomidin mixture will be injected intraarticularly at the end of the surgery.; 10 ml of Bupivacaine ve magnesium sulfate mixture will be injected intraarticularly at the end of the surgery.
Other intervention name(s): bupivacaine; bupivacaine
Intervention MeSH terms: Magnesium Sulfate; Dexmedetomidine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Analgesia; Anesthesia; Arthroscopy; Bupivacaine; Dexmedetomidine; Injections, Intra-Articular; Magnesium; Pain, Postoperative