Fentanyl vs Dexmedetomidine for Arthriscopic Shoulder Intervention in Elderly, a Randomized Comparative Study
Status:
Recruiting
Trial end date:
2022-12-01
Target enrollment:
Participant gender:
Summary
Arthroscopic shoulder surgeries are commonly used as a minimally invasive surgery for
shoulder diseases. however, it causes moderate-to-severe pain and needs stabilization of
hemodynamics, without compromising the patient, to the degree that lessens the intraarticular
bleeding to provide adequate visualization by the surgeon owing to inability to use a
tourniquet in this situation.
Opioids have known side effects, like respiratory depression, postoperative nausea and
vomiting, pruritus, difficulty in voiding, and ileus. These complications may lead to a
prolonged hospital stay.
The elderly patients are predisposed to a greater hemodynamic changes due to the higher
resting sympathetic tone ,altered beta receptor sensitivity , depleted intravascular volume
because of frequent use of diuretics, increased myocardial stiffness ,increased arterial
stiffness, reduced sinus node function and baroreceptor responsiveness and other patients
comorbidities. So they are at increased risk complications as myocardial infarction, stroke
and delirium.
Opioid free anesthesia is a technique with no opioids administered intraoperatively through
either systemic, neuraxial, or tissue infiltration routes. The number of case reports and
small prospective studies from all over the world supports its benefits.
OFA depends on combinations of non-opioid agents and adjuncts, including lidocaine,
magnesium, dexmedetomidine, ketamine,and dexamethasone to produce anesthesia, and analgesia.
Dexmedetomidine is an a2 agonist that possesses anxiolytic, anesthetic, hypnotic, and
analgesic properties. In addition, it reduces the pressor responses mediated by the
sympathetic nervous system.
Lignocaine is a short-acting amide local anaesthetic agent. It is potent as a sodium channel
blocker and has been shown to provide excellent analgesia when administered intravenously .
The evidence base supports lignocaine as an analgesic agent, an opioid-sparing agent, an
anti-inflammatory and a co-anaesthetic.
n,Complex regional pain syndrome,opioid-tolerant patient and early recovery after surgery,
however, few studies focused on its ablility to improve the surgical field condition which
depends on the hemodynamics especially in elderly patients.
Aim is to Compare OFA with Opioid anesthesia (OA) as regards improvement of the surgical
field condition in elderly patients undergoing arthroscopic shoulder surgery under general
anesthesia.