Comparative Effects of Intra-Articular Dexmedetomidine and Tramadol on Postoperative Analgesia and Hemodynamic Stability Following Arthroscopic Knee Surgery Under Spinal Anaesthesia.

Objective: Arthroscopic knee surgery is frequently performed as a day-care procedure; however, inadequate postoperative analgesia may delay mobilization, rehabilitation, and discharge. Intra-articular administration of local anaesthetics with adjuvants is an effective strategy for improving postoperative pain control. This study aimed to compare the analgesic efficacy and hemodynamic stability of intra-articular dexmedetomidine and tramadol when used as adjuvants to ropivacaine in patients undergoing arthroscopic knee surgery under spinal anaesthesia during the early postoperative period. Methodology: This prospective, randomized, double-blind, controlled study included 60 adult patients aged 18–60 years with ASA physical status I or II scheduled for elective arthroscopic knee surgery. All patients received low-dose spinal anaesthesia. Participants were randomly allocated into three groups: Group I received intra-articular ropivacaine with dexmedetomidine, Group II received ropivacaine with tramadol, and Group III received ropivacaine with normal saline. Postoperative pain was assessed using the visual analogue scale (VAS) at 0, 2, 4, 6, 12, and 24 hours. Time to first rescue analgesia, total rescue analgesic requirement, haemodynamic parameters, sedation scores, and adverse effects were recorded and analysed statistically. Results: Demographic characteristics and baseline haemodynamic variables were comparable among the three groups. The time to first rescue analgesia was significantly prolonged in the dexmedetomidine group compared with the tramadol and control groups (p < 0.001). VAS scores were significantly lower in patients receiving dexmedetomidine during the early postoperative period. Total rescue analgesic consumption was also significantly reduced in this group. Haemodynamic parameters remained stable across all groups, and no clinically significant adverse effects were observed. Conclusion: Intra-articular dexmedetomidine, when used as an adjuvant to ropivacaine, provides superior and prolonged postoperative analgesia with reduced rescue analgesic requirements compared to tramadol, without increasing adverse effects. It represents a safe and effective option for postoperative pain management following arthroscopic knee surgery under spinal anaesthesia