Abstract
<jats:p>The high intensity of postoperative pain during knee arthroscopy necessitates optimization of analgesic strategies through the implementation of regional anesthesia protocols incorporating modern adjuvants. Perineural administration of dexmedetomidine has been shown to prolong the antinociceptive effect; therefore, determination of its minimum effective dose remains an important clinical objective. Objective. To compare the clinical efficacy and safety of standard and modified regional anesthesia techniques using dexmedetomidine in arthroscopic anterior cruciate ligament reconstruction of the knee joint based on postoperative pain intensity and psycho-emotional status of patients. Materials and Methods. A prospective randomized study was conducted involving 120 patients with anterior cruciate ligament injury undergoing arthroscopic knee reconstruction. The patients were allocated into three groups: standard spinal anesthesia with bupivacaine, modified spinal anesthesia with the addition of dexmedetomidine, and combined regional anesthesia combining unilateral spinal anesthesia, femoral and sciatic nerve blocks, and low-dose dexmedetomidine. Postoperative pain intensity, psycho-emotional status, requirement for additional analgesia, hemodynamic parameters, and the incidence of adverse reactions were assessed over 48 hours following surgery. Results. The use of unilateral spinal anesthesia combined with femoral and sciatic nerve blocks and low doses of dexmedetomidine provided more effective postoperative analgesia, delaying the onset of pain syndrome for up to 12 hours and reducing its intensity to 2.10±0.84 points on the Visual Analog Scale compared to standard spinal anesthesia and modified spinal anesthesia with dexmedetomidine (p<0.001). This technique also significantly reduced the level of psycho-emotional tension, decreased the incidence of severe pain by 2.5 times, and was characterized by an acceptable complication rate (12.5–15%). Conclusions. Combined regional anesthesia using dexmedetomidine can be considered an optimal and safe method of anesthetic management for arthroscopic anterior cruciate ligament reconstruction of the knee joint.</jats:p>