Adjunctive Intravenous Dexmedetomidine's Effect on Surgical Visualization and Analgesia in Arthroscopic Bankart Repair: A Retrospective Cohort Study.

Background/

Objectives

Optimizing surgical visualization via controlled hypotension and managing postoperative pain remain challenging in arthroscopic Bankart repair. While interscalene brachial plexus block (ISBPB) is effective, pharmacological adjuncts may further improve hemodynamics and prolong analgesia. The aim of this study was to assess the impact of intraoperative intravenous dexmedetomidine on visual clarity, hemodynamics, and postoperative pain during arthroscopic Bankart repair.

Methods

This retrospective, single-center cohort study evaluated 63 patients undergoing isolated anterior Bankart repair under ISBPB. The dexmedetomidine group (Group D, n = 33) received an intravenous dexmedetomidine loading dose (1 mcg/kg) and maintenance infusion (0.5 mcg/kg/h) alongside ISBPB. A historical control group (Group C, n = 30) received ISBPB alone. Secondary outcomes included serial intraoperative hemodynamics, blinded surgeon-rated surgical visualization, and pain scores, while the primary outcome was postoperative analgesia duration.

Results

Baseline characteristics were comparable between groups. Group D yielded significantly higher surgeon satisfaction for visual clarity (p < 0.001). Intraoperatively, Group D showed a significantly lower diastolic blood pressure at the 50 min mark after correction for multiple comparisons. Postoperatively, Group D exhibited significantly lower 24 h visual analog scale (VAS) pain scores (p < 0.001) and a significantly prolonged duration of analgesia (7.45 vs. 4.16 h; p = 0.001). Overall patient satisfaction and Pain Catastrophizing Scale scores did not differ significantly between cohorts.

Conclusions

In this retrospective cohort, adjunctive intravenous dexmedetomidine added to ISBPB was associated with improved surgeon-rated visualization, lower postoperative pain scores, and prolonged analgesia, without an increase in adverse events. Due to the retrospective design and historical control group, these findings should be interpreted as associations; prospective randomized trials are required to confirm them.