Can the addition of dexamethasone, dexmedetomidine, or their combination prolong the duration of pain relief following adductor canal block for ambulatory anterior cruciate ligament repair surgery? A prospective, randomized, placebo-controlled, double-blind study.

WCH - Women's College Hospital Academic and Medical Services Group

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Can the addition of dexamethasone, dexmedetomidine, or their combination prolong the duration of pain relief following adductor canal block for ambulatory anterior cruciate ligament repair surgery? A prospective, randomized, placebo-controlled, double-blind study.

Proposal Abstract

Nerve blocks ("freezing") reduce pain, expedite discharge, and improve the quality of recovery after surgery, but the duration of pain relief is limited to 8 hours, corresponding to the maximum duration of action of the local anesthetic. Patients having ambulatory orthopedic surgery can experience severe pain at home once the local anesthetic wears off, requiring strong opioids or even a visit to the emergency room. The need to prolong the duration of nerve blocks is especially important amidst our current opioid crisis. Mixing in different types of medications can prolong the duration of local anesthetics. We previously demonstrated that small doses of dexamethasone, a commonly-used steroid, can extend the duration of pain relief when added to the local anesthetic for outpatient hand surgery. Most recently, we demonstrated that small doses of dexmedetomidine, a sedative, can meaningfully prolong the duration of pain relief when added to the local anesthetic for outpatient shoulder surgery. Dexamethasone and dexmedetomidine exert their effects through independent mechanisms, thus we aim to explore whether or not combining these two adjuncts offers any additive or synergistic benefit compared to using either one of them alone.

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