A Comparative Study of Periarticular Infiltration with Dexmedetomidine versus Ketorolac as an Additive to Ropivacaine after Total Knee Arthroplasty: A Prospective, Randomized Double-Blind Study

BACKGROUND: Periarticular infiltration (PAI) analgesia has been found to be an effective analgesia modality after total knee arthroplasty (TKA). Dexmedetomidine has many beneficial effects on postoperative analgesia by different routes, but studies on PAI are lagging. AIMS AND OBJECTIVES: In this study, we compared postoperative analgesia after PAI with dexmedetomidine versus ketorolac as an additive to ropivacaine after TKA. SETTING AND DESIGN: This is a prospective, randomized, double-blind study conducted on 75 patients belonging to American Society of Anesthesiologists I to III, undergoing total knee arthroplasty, of either gender, belonging to American Society of Anesthesiologists I to III. MATERIALS AND METHODS: After institutional ethics committee approval and written informed consent, patients were randomly allocated into three groups. Group C (n = 25) received cocktail of 60 mL ropivacaine (0.25%) infiltration with adrenaline 5 mL (0.1 mg.mL(−1)), Group D (n = 25) received additive dexmedetomidine 1 ug.kg(−1) to above cocktail, and Group K (n = 25) received ketorolac 30 mg. Postoperatively pain by Visual Analog Scale, vitals, total duration of analgesia, need for rescue analgesia, sedation, patient satisfaction, mobilization time, and complications were recorded. STATISTICAL ANALYSIS: The Statistical Package for the Social Sciences version 20 was used for statistical analysis. Analysis of variance has been used to find the significance of study parameters between the three groups of patients. P < 0.05 was considered statistically significant. RESULTS: Postoperative pain score was lesser in the ketorolac group (1.52 ± 0.71, P = 0.001) than the other two groups. Duration of analgesia was more with ketorolac (343.00 ± 144.45, P < 0.001) compared with the other two groups, and epidural activation timings (462 ± 235.84) were significantly delayed in Group K compared to Group C and Group D. There was no significant difference in mobilization time, patient satisfaction, and complications between the three groups. CONCLUSION: Ketorolac was a better additive to ropivacaine than dexmedetomidine for postoperative analgesia after TKA.