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Combined Intrathecal Dexmedetomidine and Adductor Canal Block for Analgesia in Total Knee Arthroplasty: A Randomized

Sherif Kamal Arafa¹, Ahmed Abdelaziz A Shama², Mohammad Fouad Algyar¹

¹Kafr Elsheikh University, Kafr Elsheikh, Arab Republic of Egypt.

|June 9, 2026

Abstract

Background:

Pain management following total knee arthroplasty (TKA) is critical for enhancing outcomes such as minimizing opioid consumption and hospital stay, overall function, and rehabilitation.

Objectives:

To evaluate the effectiveness of combined intrathecal dexmedetomidine (ITD) and adductor canal block (ACB) in relieving post TKA pain.

Study Design:

Double-blind, randomized controlled trial.

Setting:

KafrElsheikh University, Kafrelsheikh, Arab Republic of Egypt.

Methods:

A total of 75 patients, aged 18 to 75, who underwent TKA under spinal anesthesia participated in this double-blind, randomized controlled trial.. Three equal sets of patients were formed. Group ITD patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg of dexmedetomidine (DEX) in 0.5 mL (total volume 3.5 mL) and an ACB with 20 mL of 0.9% saline. Group ACB patients received an intrathecal injection containing 15 mg of hyperbaric bupivacaine along with 0.5 mL of saline and an ACB with 20 mL of 0.25% bupivacaine. Group ITD+ACB patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg in 0.5 mL of DEX and an ACB using 20 mL of 0.25% bupivacaine. The amount of morphine taken in the first postoperative 48 hours was the primary outcome.

Results:

Compared to Group ITD and Group ACB, the total amount of morphine needed in the first postoperative 24 and 48 hours was significantly lower in Group ITD+ACB, and in group ACB compared to group ITD (P < 0.05). Visual Analog Scale pain scores were markedly reduced in Group ITD+ACB and in Group ACB than in Group ITD at postoperative 4 hours (P = 0.018 and P = 0.041, respectively); in Group ITD+ACB than in Group ITD and Group ACB at postoperative 8 hours (P = 0.005 and P = 0.011, respectively); and in Group ITD+ACB compared to Group ITD at postoperative 12 hours (P = 0.005). The time to the first rescue analgesic was notably longer in Group ITD+ACB compared to Group ITD and Group ACB (P value < 0.05)and in Group ACB compared to Group ITD (P < 0.001). Side effects were similar in all 3 groups.

Limitations:

Our trial had a relatively limited sample size and was conducted at a single center.

Conclusions:

Combined ITD and ACB were superior in TKA postoperative pain management and required decreased postoperative analgesia without significant side effects compared to ACB alone or ITD alone.

Keywords:

Intrathecal dexmedetomidine adductor canal block analgesia pain total knee arthroplasty

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