Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy

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Abstract Background In arthroscopic knee surgery, managing postoperative pain is crucial for patient outcomes. Dexamethasone, combined with local anesthetics in adductor canal block, offers potential advantages, such as vasoconstriction and anti-inflammatory effects. This approach proves safe, prolongs sensory block duration, delays the need for analgesics, and enhances patient satisfaction, addressing challenges associated with epidural analgesia and femoral nerve block. Overall, it signifies a valuable strategy in anesthesia practice, contributing to prolonged analgesia, reduced opioid use, and faster recovery in knee arthroscopy. Aim of the Work The study aims to assess the effectiveness of perineural dexamethasone combined with bupivacaine in adductor canal block for postoperative pain control following knee arthroscopy with spinal anesthesia. The primary focus is on determining the duration of postoperative analgesia. Secondary objectives involve evaluating the effectiveness of analgesia one day after surgery and assessing opioid consumption. Patients and Methods This randomized, double-blinded controlled trial at Ain Shams University hospitals investigates the efficacy of adductor canal block with dexamethasone in knee arthroscopy under spinal anesthesia. Sixty adult patients are randomly assigned to receive either bupivacaine with dexamethasone (Group A) or bupivacaine with saline (Group B). Primary outcomes include postoperative analgesia duration, and secondary outcomes involve morphine use, patient demographics, surgical time, and complication rates. Ethical considerations and detailed study procedures are outlined, ensuring patient safety and methodological rigor. Results In a randomized study for arthroscopic knee surgery, dexamethasone added to bupivacaine in adductor canal block significantly extended sensory block duration and delayed the time to first analgesic requirement. Visual analog scale scores were lower, and morphine consumption was reduced over 24 hours postoperatively. While systemic effects of dexamethasone were not assessed, consistent with other studies, its addition to local anesthetics in various nerve blocks demonstrated prolonged analgesia. Patient satisfaction was notably higher in the dexamethasone group, likely influenced by increased pain relief duration and reduced side effects. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg) dexamethasone to (0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.