Abstract
<jats:p>Background. Perioperative pain control during knee arthroscopy is a major challenge for both surgeons and anaesthesiologists. Spinal anaesthesia is a safe and reliable method with the advantages of rapid onset of action, it provides better pain control and is easy to perform and cost-effective method. Adding femoral and sciatic nerve blocks to spinal anaesthesia improves postoperative pain relief and maintains range of motion, suggesting potential clinical benefits in pain management and functional recovery. Of the new local anaesthesia aids, dexmedetomidine best demonstrated the ability to significantly increase the duration of blocks. Examination of the correct dose as an adjuvant in peripheral nerve block, efficacy of dexmedetomidine in time and intensity of analgesia seems promising. The purpose of the study: to compare the effectiveness and safety of modified spinal anaesthesia using dexmedetomidine adjuvant (SA+D) with combined modified regional anaesthesia (unilateral spinal anaesthesia with femoral and sciatic nerve block using small doses of dexmedetomidine solution, SA+B+D). Materials and methods. Two groups of 40 patients each, both men and women, who underwent arthroscopic repair for the anterior cruciate ligament injury. First group (SA+D): age of 40.73 ± 9.99 years, ASA I–II. Second group (SA+B+D): age of 39.00 ± 11.56 years, ASA I–II. The SA+D group received the isobaric solution of 0.5% bupivacaine 13 mg and dexmedetomidine 100 μg intrathecally, the SA+B+D group was intrathecally administered the isobaric solution of 0.5% bupivacaine 8 mg and fentanyl 20 μg; for femoral and sciatic nerve block, 0.25% bupivacaine 20 ml, dexmedetomidine 100 μg each were used. Both groups underwent the perioperative analysis and comparison of hemodynamic indicators (systolic and diastolic blood pressure, pulse), dynamics of stress markers: level of cortisol, lactate and blood glucose, antinociceptive protection: visual analogue scale (VAS), numeric rating scale of pain (NRS), indicators of psycho-emotional comfort: Zung Self-Rating Depression Scale, Hospital Anxiety and Depression Scale, presence of side effects and complications. Results. Moderate hypertension in patients of the SA+D group (127.88 ± 10.43 mmHg) was noted at the 8th hour of the postoperative period, in the SA+B+D group (128.98 ± 12.73 mmHg) — at the 12th hour (p < 0.001). No significant discrepancies were found between the mean saturation scores in both groups (p < 0.05). Post-surgery glycemia in patients of the SA+D group is greater (5.17 ± 0.56 mmol/l) than in the SA+B+D group (4.82 ± 0.44 mmol/l) (p < 0.02). The VAS score was lower in the SA+B+D group at 4, 8, 12, 24 hours (p < 0.001). The Zung scale score was lower in the SA+B+D group at 4, 8 hours (p < 0.04). In the SA+D group, there was a higher frequency of severe pain syndrome, hypotension and tachycardia, postoperative nausea, in the SA+B+D group, postoperative nausea was not observed. Conclusions. 1. SA+B+D provides better control of hemodynamic parameters (p < 0.05), stable plasma levels of glucose (p < 0.02), lactate (p < 0.001) and cortisol (p < 0.05) perioperatively than SA+D. 2. The use of SA+B+D, compared to SA+D, is associated with a delayed onset of first pain sensations up to 8–12 hours (p < 0.05) and lower rates of acute postoperative pain (p < 0.02). 3. Combined modified regional anaesthesia with femoral and sciatic nerve block using dexmedetomidine at a dose of 100 µg may be the anaesthesia of choice in arthroscopic repair of the anterior cruciate ligament.</jats:p>