Effect of Dexmedetomidine on Levobupivacaine and Ropivacaine in Fascia Iliaca Block for Trochanteric Fractures Treated by Proximal Femoral Nail - A Randomized Trial.

backgroundFascia iliaca block (FIB) is an established procedure for postoperative pain relief in femur fracture surgeries. Dexmedetomidine was found to be a useful additive to local anesthetics (LA) for peripheral nerve blocks resulting in a prolonged anesthetic effect. We evaluated the impact of the addition of dexmedetomidine to an equal concentration of levobupivacaine and ropivacaine for FIB.  Methods: The present study is a double-blind, randomized trial conducted on 60 patients in the age group 18-70 years. The patients were divided into two groups: Group LD received 30 ml of an LA solution (29.5 ml 0.25% levobupivacaine and 0.5 ml dexmedetomidine 50 µg), and group RD received 30 ml of another LA solution (29.5 ml 0.25% ropivacaine and 0.5 ml dexmedetomidine 50 µg). The outcomes observed were the duration of analgesia (DOA) and total analgesic requirement (TAR).

resultsThe DOA was found to be slightly longer in group LD (955.3 ± 114.5 minutes) than in group RD patients (894.6 ± 91.3) with p = 0.027. The TAR was found to be statistically different though clinically irrelevant (group LD: 112 mg; IQR: 105-122 vs. Group RD: 115 mg; IQR: 104-118, p = 0.034, where IQR stands for interquartile range). There were no signs of neurotoxicity in any of the participating patients.

conclusionAddition of 50 µg dexmedetomidine to 0.25% levobupivacaine extends DOA slightly as compared to when dexmedetomidine is added to 0.25% ropivacaine. However, TAR remains clinically the same for both cases in fascia iliaca block.