Abstract
Background: Arthroscopic knee surgery causes significant postoperative pain, delaying functional recovery, extending hospital stays, and reducing patient satisfaction. The goal of this study was to compare the analgesic efficacy of adductor canal block (ACB) and intravenous dexamethasone with intrathecal morphine, as well as their adverse effects.
Methods: A clinical trial, randomized, comparative study. Nighty two patients aged over 18 years old, ASA status of I to III who undergo arthroscopic knee surgery. They were randomized into two groups. All patients undergo spinal anesthesia with heavy bupivacaine and fentanyl, 1 g IV paracetamol per 8 hours postoperatively. One group received 100 mcg of intrathecal morphine (M group), and the another group received 20 mL of 0.25% levobupivacaine for ACB and 8 mg IV dexamethasone (S group). Postoperative pain scores at rest and active were assessed using a visual analogue scale (VAS), the rate and time of first rescue pain requirement, adverse outcomes, patient satisfaction, quality of recovery were also assessed.
Results: VAS score of both groups were lower or equal to 3 at all time intervals. The rate of rescue pain requirement in the S group (8.7%) and M group (6.5%, p-value > 0.05). The mean time to first analgesic request in the S group (11.4 ± 3.5 hour) and M group (16.6 ± 2.6 hour, p-value > 0.05). 39.1% patients experienced nausea and vomiting, 37% patients experienced pruritus in the M group, the rates in the S group were negligible at 0%, and 4,3% patients respectively, p-value < 0.05. The rates of urinary retention in the M and S groups are 10.9% and 4.3%, respectively, p-value > 0.05. No patients of respiratory depression was recorded in both groups. Satisfaction rate was significantly lower in the M group (34.8% very satisfied) when compareration with S group (69.6% very satisfied, p-value < 0.05). The QoR-15 score in the S group was higher than M group at both 12 and 24 hours, p-value < 0.05.
Conclusions: Both methods provides effective for postoperative analgesia in patients undergoing arthroscopic knee surgery. Adductor canal block combined with intravenous dexamethasone is better than intrathecal morphine regarding the rate of adverse events, patient satisfaction, and quality of recovery.
| Published | 2025-06-25 | |
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| Issue | Vol. 15 No. 3 (2025) | |
| Section | Original Articles | |
| DOI | 10.34071/jmp.2025.3.14 | |
| Keywords | gây tê ống cơ khép (OCK), dexamethason, morphin khoang dưới nhện (morphin KDN), giảm đau sau phẫu thuật, phẫu thuật nội soi khớp gối, thang điểm nhìn hình đồng dạng (VAS) adductor canal block (ACB), dexamethasone, intrathecal morphine, postoperative analgesia, arthrocsopic surgery, visual analog scale (VAS) |
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