Perineural vs. intravenous dexmedetomidine as an adjunct to bupivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries: A randomised control trial

BACKGROUND AND AIMS: Perineural and intravenous dexmedetomidine as a local anaesthetic adjunct has not been compared previously in fascia iliaca compartment block (FICB). The aim of this study was to compare the efficacy and side effect profile of dexmedetomidine as an adjunct to bupivacaine in single dose FICB for femur surgeries in two different routes i.e., perineural and intravenous route. METHODS: Eighty American Society of Anesthesiologists physical status 1, 2 or 3 patients posted for femur surgeries were randomised to receive ultrasound guided FICB. Intravenous group(ID) received 40 mL of 0.25% bupivacaine with 2 mL of 0.9% saline for FICB along with 1 μg/kg dexmedetomidine intravenous infusion over 30 min as loading dose followed by 0.5 μg/kg/h as maintenance dose till the end of surgery. Perineural group (LD) received 40 mL of 0.25% bupivacaine with 2 mL of 1 μg/kg dexmedetomidine for FICB. M ean duration of postoperative analgesia and 24 h postoperative morphine consumption as primary and secondary outcome respectively, has been compared. RESULTS: The duration of postoperative analgesia was 8 h 36 min ± 1 h 36 min and 10 h 42 min ± 1 h 36 min for the ID and LD groups, respectively (P = 0.001). A 24 h postoperative morphine consumption in Group ID was 19.7 ± 1.9 mg compared to 17.5 ± 2.2 mg in LD groups (P = 0.001). CONCLUSION: Perineural dexmedetomidine effectively prolongs the USG guided FICB analgesic duration and reduces the 24 h postoperative morphine consumption when compared to intravenous dexmedetomidine as a local anaesthetic adjuvant for femur surgeries.