Adjuvant Strategies for Spinal Anesthesia in Knee Arthroscopy: A Comparative Review of Dexmedetomidine, Magnesium Sulphate, and Fentanyl | ||
| Zagazig University Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 04 October 2025 | ||
| Document Type: Review Articles | ||
| DOI: 10.21608/zumj.2025.422852.4180 | ||
| Authors | ||
| Tarek Yousef Gaafar1; Salwa Hassan Waly1; Mostafa Ibrahim Ramadan2; Kareem Mohamed Abdel Azeem* 3 | ||
| 1Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University | ||
| 2Lecturer of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University | ||
| 3Resident of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University | ||
| Abstract | ||
| Background: Knee arthroscopy is a common orthopedic procedure that requires an anesthetic technique with rapid onset, stable hemodynamics, and minimal side effects to allow early mobilization and discharge. Selective spinal anesthesia (SSA) using low-dose hyperbaric bupivacaine has gained interest for its ability to provide targeted blockade and faster recovery compared with conventional spinal anesthesia, though its relatively short and sometimes inconsistent duration remains a limitation. To address this, several intrathecal adjuvants have been evaluated, and this review aims to compare the efficacy and safety of dexmedetomidine, magnesium sulphate, and fentanyl when combined with low-dose bupivacaine in SSA for knee arthroscopy. Conclusion: Current evidence suggests that dexmedetomidine provides the most consistent prolongation of block and superior analgesia, though bradycardia and hypotension may occur. Fentanyl offers rapid and dense analgesia with minimal motor prolongation but carries opioid-related side effects, while magnesium provides modest block extension with a favorable safety profile. Tailored adjuvant use optimizes anesthetic efficacy and recovery outcomes. | ||
| Keywords | ||
| Spinal Anesthesia; Knee Arthroscopy; Dexmedetomidine; Magnesium Sulphate; Fentanyl | ||
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