Dexmedetomidine as an Adjuvant in Femoral Nerve Block for Ease of Preoperative Positioning and Postoperative Analgesia in Hip and Proximal Femur Surgery.

BACKGROUND: Perineural dexmedetomidine has been shown to improve block quality, accelerate onset, and prolong block duration when used as an adjuvant to local anaesthetics. OBJECTIVES: This study assessed the effects of adding dexmedetomidine to bupivacaine in an ultrasound-guided femoral nerve block (USG-FNB) on positioning for spinal anaesthesia and postoperative analgesia in patients undergoing surgery for hip and proximal femur fractures. METHODS: This hospital-based observational study included 100 adults undergoing surgery for hip or proximal femur fractures. Using convenience sampling, participants were classified into two groups of 50 according to the femoral nerve block received: Group C received bupivacaine alone, and Group D received bupivacaine with dexmedetomidine at 1 µg/kg as an adjuvant. Once the visual analogue scale (VAS) score was < 3, patients were placed in the sitting position, and spinal anaesthesia was administered. RESULTS: Median heart rate was significantly higher in Group D than in Group C at all assessed time points, except at 3 hours, when the groups were comparable. Participants in Group D achieved a VAS score < 3 significantly sooner after the block and had a significantly longer time to first rescue analgesia postoperatively than those in Group C (P = 0.001). Time to recovery from spinal anaesthesia was similar between groups. The mean number of rescue analgesic doses was significantly higher in Group C than in Group D. CONCLUSIONS: Dexmedetomidine demonstrated a superior analgesic profile as an adjuvant to a femoral nerve block, facilitating patient positioning for spinal anaesthesia and reducing postoperative rescue analgesic requirements.