Comparison of the Effect of Adding Dexmedetomidine as an Adjuvant to Bupivacaine for Postoperative Pain Management in Patients Undergoing Shoulder Rotator Cuff Repair - A Randomized Clinical Trial.

Abstract

Background: Shoulder rotator cuff repair postoperative pain management is more critical than orthopedic surgeries in other limbs. This study aimed to investigate the effect of adding dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management.

Materials and methods: This double-blind, randomized clinical trial was performed on 80 patients aged 20 to 60 with ASA I and II who were candidates for elective shoulder rotator cuff repair. Forty candidates in the control group received 0.1% bupivacaine intra-articular and extra-articular before surgical wound closure, and 40 patients in the intervention group received 0.1% bupivacaine and dexmedetomidine 1 µg/kg intra-articular and extra-articular. Postoperative sleep disturbance and pain intensity were measured at recovery, 4, 8, 12, 18, and 24 hours after surgery. The results were analyzed by SPSS software version 23, and a P value ≤0.05 was considered significant.

Results: There were no significant differences between the two groups regarding the hemodynamic variations (P > 0.05), except 4 hours after surgery when the mean arterial pressure in the intervention group was significantly lower than the control group (P = 0.026). There was a significant reduction in pain scores at 8 and 12 hours after surgery in the intervention group. The night after surgery, sleep quality and the overall RCSQ score in the intervention group were significantly higher than those in the control group.

Conclusion: Administering 0.1% bupivacaine and dexmedetomidine 1 µg/kg intra-articular and extra-articular before surgical wound closure effectively reduced the pain intensity and analgesic consumption. Also, it maintained patients' hemodynamic stability and enhanced sleep quality without significant adverse effects.