The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study.

Abstract

This randomised, controlled, double-blind study investigated the effects of different doses of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block in patients undergoing arthroscopic knee surgery. Ultrasound-guided femoral nerve block was performed before general anaesthesia using 25ml of bupivacaine 0.5% combined with normal saline in the control group, and 25μg, 50μg or 75μg of dexmedetomidine in three treatment groups (n=15 for each group). All patients received a standard general anaesthetic and multimodal postoperative analgesic regimen. The use of the 50μg and 75μg dose levels of dexmedetomidine was associated with reduction of the onset time, extension of the duration of block, prolonged time to the first postoperative request for rescue analgesia, and reduced postoperative morphine requirements. The times to first request for postoperative analgesia were mean (SD) 10.8 (1.6)h in the control group and 11.0 (7.1), 21.8 (3.0) and 28.6 (10.0) in the 25μg, 50μg and 75μg treatment groups, respectively. These times were significantly longer in the 50μg and 75μg treatment groups compared with the 25μg (p<0.0001) and control group (p<0.0001). The total 24-h postoperative morphine consumption was 7.6 (5.1)mg in the control group, and 6.5 (3.5), 3.9 (3.4), 1.8 (2.6) in the 25μg, 50μg and 75μg treatment groups, respectively. Postoperative morphine consumption was significantly higher in the control group compared with the 50μg (p=0.045) and the 75μg (p=0.001) treatment groups. The best analgesic profile was achieved at the 75μg dose, but this was associated with increased risk of hypotension.