The Efficacy of Adding Dexmedetomidine Perineurally to Bupivacaine in Ultrasound Guided Fascia Iliaca Block Versus Intravenously Infused Dexmedetomidine on Hemodynamic Stability Intraoperatively and Postoperative Analgesia Following Hip Arthroscopy
Condition: Anesthesia
Study type: Interventional

Summary: 
      The current study aims to assess effectiveness of dexmedetomidine as adjuvant to general
      anesthesia on the hemodynamic stability and narcotic consumption intraoperatively and its
      effect as adjuvant to fascia iliaca compartment block (FICB) with bupivacaine on the
      postoperative analgesia following hip arthroscopy (decrease the need to narcotics
      postoperatively avoiding their complications and increasing the success rate of surgery, by
      enhancing patients to move easier).
    

Detailed description: 
      This study is a randomized controlled trial at Ain Shams university hospital, Cairo, Egypt.
      The study will include 88 patients (44 patients) in each group planned for undergoing hip
      arthroscopy under general anesthesia, will be randomly assigned into one of the following two
      groups using computer generated codes and opaque sealed envelopes:

      All patients will range from ASA I or II, planned for elective hip arthroscopy, aging from 18
      to 65 years, body weight renge from 70- 80 Kg of both sexes.

      Patients will receive 0.03 mg/kg intravenous (IV) midazolam as a preanesthetic medication,
      and 1 mg Granisetron as a postoperative nausea and vomiting (PONV) prophylaxis after
      application of routine monitoring (electrocardiogram, non-invasive blood pressure monitoring
      and oxygen saturation (SPO2)).

      A standard anaesthetic technique will be followed. After preoxygenation for three minutes,
      anaesthesia will be induced with: propofol 2-3 mg/kg, fentanyl 1µg/kg. Atracuirium besilate
      0.5 mg/kg will be used to provide muscle relaxation. All patients will be mechanically
      ventilated with a tidal volume of 8 ml/kg. 1-2 minimum alveolar concentration (MAC) of
      isoflurane mixed with oxygen (50%) and air (50%) will be used for maintenance of anesthesia.

      GROUP A will receive Dexmedetomidine in dose of of 0.5μg/ kg/hour It elicits a biphasic blood
      pressure response: a short hypertensive phase followed by hypotension. It is expected that
      the decreased blood pressure and heart rate, will happen with ongoing therapy within 15
      minutes, mediated by central α2A-AR, that decrease the release of noradrenaline from the
      sympathetic nervous system (10) And that is the reason we will start Dexmedetomidine infusion
      just after intubation.

      Then Ultrasound-guided block was performed in supine position, inguinal ligament was
      identified, and crease area was sterilized using povidone iodine. Using a 7.5 -12 MHz linear
      probe, started on the inguinal crease parallel to the inguinal ligament, and after
      identification of femoral artery, a little movement of the probe laterally till iliopsoas
      muscle was specified as a hypo echo part in lateral to the artery and femoral nerve. It is
      covered by a hyperechoic fascia, which separates the muscle from the subcutaneous tissue,
      using the in-plane technique a 22G/80 mm insulated echogenic block needle was inserted and
      advanced towards the fascia iliaca and iliopsoas muscle. Confirming the passage of the needle
      through the fascia iliaca using fascial click and 2mL of saline. LA was injected between
      fascia iliaca and iliopsoas muscle, we used ultrasound guided hydro dissection technique.
      Through this hydro dissection, the needle was moved towards the space created by the injected
      LA. The responsible anesthesiologist and the patient were unaware of the nature of drug in
      each syringe and master codes were stored by personnel who did not participate in
      observation.

      Mean arterial blood pressure (MABP) and heart rate (HR) will be measured. Any increase or
      decrease in HR or blood pressure, will be managed as required after exclusion of a surgical
      cause. For example, MABP or HR rise of > 20% above baseline will be treated by administering
      a 0.5 μg/kg intravenous bolus of fentanyl.

      MABP drop of > 20% below baseline will be dealt with reduction of the isoflurane
      concentration to 0.6%. If patient is still hypotensive, 6 mg ephedrine will be given
      intravenously. Finally, bradycardia will be treated with: 0.6 mg IV atropine bolus and
      repeated as required.

      Fentanyl (0.5µg/kg IV) will be titrated intraoperatively at the discretion of the attending
      anaesthesiologists up to one hour prior to the end of surgery. No other intraoperative
      adjunct analgesic will be given.
    

Intervention name(s): Bupivacaine hydrochloride perineurally; Dexmedetmidine infusion; Dexmedetomidine perineurally
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Arm 1; Bupivacaine hydrochloride 40 ml 0.25% perineurally in FICB; Arm 1: infusion of Dexmedetmidine 0.5 µg/kg/h; Arm 2:Dexmedetomidine perineurally in FICB 80µg
Other intervention name(s): marcaine; precedex; precedex
Intervention MeSH terms: Dexmedetomidine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care