الفهرس 
ARTHROSCOPYOnly 14 pages are availabe for public view
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Abstract
Arthroscopic surgery is one of the most common surgical procedures being performed in case of knee injuries and disorders and is often associated with postoperative pain. Intra articular (IA) local analgesia has been widely used for management of pain after the arthroscopic knee surgery. Different adjuvant drugs, including opioids, non-steroidal anti-inflammatory drugs, ketamine, clonidine, dexmedetimidine, bupivacaine and neostigmine, have been used (IA) to improve pain relief, duration and quality of analgesia after knee arthroscopy . Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with less post-operative pain. Reconstruction of the anterior cruciate ligament (ACL) is usually associated with severe postoperative pain. Dexmedetomidine, a highly selective α2 adrenoceptor agonist, binds the α2 receptors up to eight times more avidly than clonidine. systemic dexmedetomidine has sedative, anxiolytic, analgesic, and anesthetic sparing effects . Lignocaine patch 5%, a topical analgesic, is a unique medication used to treat local pain. Its pharmacokinetics confer minimal systemic absorption, allowing it to have a low risk of drug- drug interaction . Lignocaine within the patch penetrates the skin and stabilizes the neuronal membranes of pain fibers by binding to receptors within sodium channels. These channels have been found to be present in abnormally high numbers in hyperactive or damaged nociceptors. Bound lignocaine blocks the influx of sodium ions, reducing the abnormal ectopic discharges produced by damaged and dysfunctional peripheral nerves . Fewer studies in the literatures about adding lignocaine 5% patch after arthroscopic knee surgery Our study was done to evaluate the effects of supplementation of intra articular bupivacaine dexmedetomidine with lignocaine 5% patch after arthroscopic knee surgery under general anesthesia. This study was approved by the Ethics Committee and was carried on fourty patients ASA І & ІІ. Admitted to Tanta University Hospital in Orthopedic Surgery Department for arthroscopic knee surgery. Inclusion criteria included adult patients ASA I & II aged between 25 to 56 years and weight between 63 to 96 scheduled for elective arthroscopic knee surgery (menisectomy 18 patients & ACL reconstruction 22 patients) & duration of the surgeries ranged from 55 min to 90 min. Exclusion criteria were patient refusal, cardiac, renal & hepatic patients or hypertensive patients treated with α methyldopa, clonidine, or beta-adrenergic blockers, or if they have used opioid or non-opioid analgesics within the previous 24 h or have previous sensitivity to local anesthetics. Patients were divided into 2 equal groups: group A (dexmedetomidine group) received 10 ml 0.5% bupivacaine and 1 mcq/kg dexmedetomidine diluted in 10 ml saline injected intra articulary after the end of arthroscopic surgery, while group B (lignocaine 5% patch) received 10 ml 0.5 % bupivacaine and 1 mcq/kg dexmedetomidine diluted in 10 ml saline injected intra articularly and a patch of lignocaine 5% was applied to the skin between the arthroscopic portals. Pethidine 20 mg was given as rescue analgesia if pain VAS ≥ 4. After the operation vital signs (heart rate, mean arterial pressure, respiratory rate and arterial oxygen saturation), postoperative pain (using point Visual Analogue Scale (VAS) where (0) no pain and (10) most intense pain), Ramsay Sedation Score(RSS), time for first postoperative required analgesia, 24 hour pethidine consumption and length of hospital stay were measured in the 2 groups immediately after recovery, 30 min, 1th hr, 2nd hr, 4th hr, 6th hr, 12th hr & 24th hr. In our study the mean values of heart rate and respiratory rate were significantly lower in lignocaine 5% patch at 6th hr postoperative while no significance in the mean value of heart rate and respiratory rate. The mean values of pain assessment by VAS in group B (lignocaine 5% patch) were lower than group A, significantly at 30 min, 6th hr, 12th hr & 24th hr and insignificantly at immediate post recovery, 1st hr, 2nd hr & 4th hr. Also we found that the mean time to the first request of pethidine was significantly longer in group B (lignocaine 5% patch), the total dose of pethidine consumption was significantly lower in group B than group A. the length of hospital stay was.