Intra-articular Dexmedetomidine Versus Neostigmine After Knee Arthroscopy (a Comparative Study)

Study Overview
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Brief Summary
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Knee arthroscopy is a minimally invasive day case procedure which may be done for diagnosis, meniscectomy or debridement. Arthroscopic surgery is associated with a variable degree of postoperative pain, which is caused by an irritation of free nerve endings of the synovial tissue, anterior fat pad, and joint capsule due to surgical excision and resection

Detailed Description
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Many studies were done using different intra-articular agents as local anesthetics, opioids, ketamine and alfa2- adrenergic agonists for prevention and treatment of pain after knee surgeries. Dexmedetomidine is a potent and highly selective alfa2-adrenoreceptor agonist. It has sedative-hypnotic, anxiolytic, analgesic, anesthetic and sympatholytic effects. Intra-articular dexmedetomidine was used in several studies to enhance postoperative analgesia after knee arthroscopy with an increased time to first analgesic request and a decreased need for postoperative analgesia Neostigmine is an anticholinesterase and also has antinociceptive effects when administered intrathecally or peripherally.

Official Title
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Comparison Between Intra-articular Dexmedetomidine and Neostigmine as Adjuvant Analgesics After Knee Arthroscopy

Conditions
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Knee Injuries

Intervention / Treatment
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* Drug: dexamedetomidine
* Drug: neostigmine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients aged above 18 years scheduled for elective arthroscopic knee surgery under intrathecal anaesthesia Exclusion Criteria: Absolute or relative contraindications for intrathecal anaesthesia, Allergy for the studied drugs. Patients having history of cardiovascular, cerebrovascular, and respiratory diseases, Patients receiving chronic pain treatment or hypertension treated with alfa methyldopa, clonidine or beta adrenergic blockers were excluded from the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients will be randomly allocated to one of two groups each including 50 patients; the group received either intraarticular dexametomidine or neostigmine .
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: dexmedetomidine (D group)<br>intraarticular administration of dexmedetomidine at the end of surgery | Drug: dexamedetomidine<br>* intraarticular injection of 1µg/kg dexametomidine +18ml 0.25%bubivacaine in a total volume of 20 ml.<br>* Other names: dexamedetomidine Hcl injection;|
| Active Comparator: neostigmine (N group)<br>intraarticular administration of neostigmine at the end of surgery. | Drug: neostigmine<br>* intraarticular injection of 0.5mg/dose neostigmine +18ml 0.25%bubivacaine in a total volume of 20 ml.<br>* Other names: prostigmine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain | visual analogue pain scale | 36 hours after the end of the surgery. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| nausea,vomiting | nausea and vomiting scales | 36 hours after the end of the surgery. | 
| sedation | Ramsay sedation score | 36 hours after the end of the surgery. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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knee arthroscopy, dexmedetomidine, neostigmine