Safety and efficiency of dexmedetomidine as adjuvant to local anesthetics.
OBJECTIVE
To review the current knowledge of dexmedetomidine as an additive drug to local anesthetics in peripheral and neuraxial regional anesthesia.


RESULTS
Recent studies show a perineural mode of action of dexmedetomidine. Pharmacodynamic characteristics of peripheral and neuraxial regional anesthetic techniques are optimized by the addition of dexmedetomidine to long-acting local anesthetics. Bradycardia and sedation are the main systemic side-effects of dexmedetomidine for regional anesthesia purposes. A dose of approximately 100 μg dexmedetomidine for peripheral techniques may represent the optimal balance between optimization of block characteristics and side-effects. Doses between 3 and 10 μg are described to be sufficient for spinal administration.


CONCLUSIONS
Dexmedetomidine has a potency to ameliorate pharmacodynamic characteristics of peripheral and neuraxial regional anesthetic techniques and is therefore currently the most promising additive drug in regional anesthesia. Future scientific efforts should focus on dose finding studies for particular regional anesthetic techniques. Approval of dexmedetomidine for regional anesthetic indications should be the final target.
aDepartment of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria bDivision of Pain Medicine, Department of Anesthesiology, The University of Michigan Medical School, Ann Arbor, Michigan, USA.
Peter
P
Marhofer
Chad M
CM
Brummett
D000759:Adjuvants, Anesthesia / Q000494:pharmacology / Q000627:therapeutic use*; D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use*; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001919:Bradycardia / Q000139:chemically induced; D020927:Dexmedetomidine / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects / Q000379:methods; D009420:Nervous System / Q000187:drug effects; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D058647:Adrenergic alpha-2 Receptor Agonists; D000700:Analgesics; D000779:Anesthetics, Local; D020927:Dexmedetomidine