Efficacy of intra-articular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery.

INTRODUCTION: Various drugs are administered intraarticularly to provide postoperative analgesia after arthroscopic knee surgery, of which opioids and alpha2 agonists could be of particular interest. METHODS: Sixty patients undergoing elective knee arthroscopy were randomly assigned to two groups (n = 30). Group R received 19 ml of 0.25% ropivacaine and 1 ml of isotonic saline (total volume 20 ml) intraarticularly. Group RD received 100 microg (1 ml) of dexmedetomidine added to 19 ml of 0.25% ropivacaine intra-articularly (total volume 20 ml). Analgesic effect was evaluated by measuring pain intensity (VAS score) and duration of analgesia. RESULTS: A longer delay was observed between intraarticular injection of study medication and first requirement of supplementary analgesic in group RD (10.84 +/- 2.6 hours) compared to group R (5.38 +/- 1.4 hours). Total consumption of fentanyl citrate in postoperative period was significantly less in group RD. No significant side effects were noted. CONCLUSION: Dexmedetomidine, added as adjunct to ropivacaine in patients undergoing arthroscopic knee surgery, improve the quality and duration of postoperative analgesia.

Prognostic value of baseline high-sensitivity C-reactive protein in patients undergoing replacement arthroplasty.

INTRODUCTION: A prospective hospital based blinded study was carried out in an orthopedics department in a medical college hospital of Kolkata, West Bengal, India, with the objective of assessing the role of pre-operative high-sensitivity C-reactive protein (hsCRP) level in predicting postoperative complications in replacement arthroplasty. METHODS: One hundred and twenty one study subjects were selected. The blood collected in preoperative, perioperative and postoperative states were stored and finally analyzed after the data collection was over after the stipulated follow-up time of post operative Day-14. The patients were divided into two groups according to baseline hsCRP level < 3 mg/dl and > 3 mg/dl. The other preoperative parameters measured were found to be statistically comparable. RESULTS: Among important findings, operative time was significantly higher in the group with hsCRP > 3 mg/dl, postoperative complication rate was also significantly more in that group. Postoperative complication in Day-7 though quite high among both the groups (45% and 50.9%), the difference was not statistically significant. Comparison of hsCRP levels at baseline, perioperative, postoperative D7 and D14 also showed no significant changes. CONCLUSIONS: We concluded that high hsCRP level (> 3 mg/dl), in patients with apparently no other risk factors may be at higher risk of developing complications after post operative D14 of replacement arthroplasty and operative time also significantly increases with high baseline hsCRP level.