Posterior Tibial Nerve Sensory Blockade Duration Prolonged by Adding Dexmedetomidine to Ropivacaine

Abstract

Dexmedetomidine, an α(2)-receptor agonist, prolongs analgesia when used in neuraxial and IV blocks. We evaluated the effect of dexmedetomidine added to ropivacaine for tibial nerve block on the duration of the sensory blockade. For this prospective, randomized, controlled, double-blind, crossover trial, 14 healthy volunteers were allocated to 2 groups. All volunteers received an ultrasound-guided tibial nerve block 4 to 5 cm proximally to the medial malleolus. In group R, 10 mL of 0.5% ropivacaine was injected for the block; in group RD, 10 mL of a solution containing 0.5% ropivacaine with 1 μg/kg of dexmedetomidine was administered. After the injection, monitoring of vital signs, evaluation of onset and resolution of sensory block, and level of sedation (Observer's Assessment of Alertness/Sedation scale) were performed. Three weeks later, the same procedure was repeated, but the study subjects were allocated to the other group in a crossover fashion. The primary end point was the duration of sensory blockade. The time and carryover effects were also evaluated. Secondary outcomes were the onset time and the presence of adverse effects such as hypotension, bradycardia, hypoxia, and sedation. Sensory blocks lasted longer in group RD than in group R (21.5 vs 16.2 hours; mean pairwise difference 5.3 hours [95% confidence interval: 3.9-6.7 hours]; P < 0.0001). Onset times were similar between groups. The mean systolic and diastolic blood pressure levels were stable throughout the study period in group R. In group RD, a noticeable decrease in systolic and diastolic blood pressure was observed between 60 and 480 minutes (P < 0.05); 2 volunteers experienced a 30% decrease in systolic blood pressure when compared with the baseline value as compared with none in group R. Heart rate was similar between groups except at 60 minutes (P < 0.01). Dexmedetomidine added to ropivacaine for tibial nerve block prolongs the duration of sensory blockade with similar onset time. However, patients should be monitored for potential adverse effects such as hypotension, bradycardia, and sedation.