Boosting Bupivacaine: The Role of Adjuvant Perineural Dexmedetomidine in Femoral Nerve Blocks.

Background Effective pain management in patients with femoral fractures, such as intertrochanteric fractures, remains a major challenge in emergency medicine. Ultrasound-guided femoral nerve blocks administered on arrival have emerged as a promising alternative to conventional parenteral analgesics due to their ease of administration, rapid onset of analgesia, prolonged sensory blockade, and reduced risk of systemic adverse effects. Dexmedetomidine, a selective α2-adrenergic agonist, has been increasingly studied as an adjuvant to local anesthetics because of its ability to hasten the onset and prolong the duration of peripheral nerve blockade. Aims and objectives This study aimed to evaluate the efficacy of perineural dexmedetomidine as an adjunct to 0.25% bupivacaine in ultrasound-guided femoral nerve blocks for pain management in patients with femoral fractures presenting to the Department of Emergency Medicine, Rajiv Gandhi Government General Hospital. Materials and methods A single physician-blinded randomized controlled trial was conducted in the Department of Emergency Medicine, Rajiv Gandhi Government General Hospital. Thirty patients with femoral fractures were enrolled and randomly allocated into two groups comprising 15 patients each. Group B received an ultrasound-guided femoral nerve block using 19 mL of 0.25% bupivacaine with 1 mL of saline. In comparison, Group BD received 0.25% bupivacaine combined with 1 mL of perineural dexmedetomidine at a dose of 1 µg/kg. The onset of sensory blockade was assessed using the pinprick test, and pain intensity was evaluated using the Visual Analog Scale. Block duration was recorded separately. Hemodynamic parameters and adverse effects were also monitored. Statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY). Results The addition of perineural dexmedetomidine to 0.25% bupivacaine resulted in a significantly faster onset of sensory blockade and prolonged duration of analgesia compared to bupivacaine alone. The mean onset of sensory blockade was 12 minutes, and the duration of analgesia was prolonged to 190 minutes in Group BD compared to 158 minutes in Group B (p = 0.001). Patients remained hemodynamically stable throughout the study period, and no significant adverse effects were noted. Conclusions The use of perineural dexmedetomidine as an adjunct to bupivacaine in ultrasound-guided femoral nerve blocks is associated with a faster onset and longer duration of analgesia in patients with femoral fractures presenting to the emergency department. This approach offers an effective and safe modality for acute pain management. Further studies with larger sample sizes are recommended to determine the optimal dose and maximize the therapeutic benefits of dexmedetomidine in peripheral nerve blocks.