title: Does Dexmedetomidine Have a Perineural Mechanism of Action When Used as an Adjuvant to Ropivacaine?: A Paired, Blinded, Randomized Trial in Healthy Volunteers.
abstract: Dexmedetomidine used as an adjuvant to local anesthetics may prolong the duration of peripheral nerve blocks. Whether this is mediated by a perineural or systemic mechanism remains unknown. The authors hypothesized that dexmedetomidine has a peripheral mechanism of action.
  
  
  
  The authors conducted a randomized, paired, triple-blind trial in healthy volunteers. All received bilateral saphenous nerve blocks with 20 ml ropivacaine, 0.5%, plus 1 ml dexmedetomidine, 100 µg/ml, in one thigh and 20 ml ropivacaine 0.5% plus 1 ml saline in the other thigh. The primary outcome measure was the duration of block assessed by temperature sensation (alcohol swab). The secondary outcome measure was the duration of block assessed by pinprick, pain during tonic heat stimulation, warmth detection threshold, and heat pain detection threshold.
  
  
  
  All 21 enrolled volunteers completed the trial. The mean duration of block assessed by temperature sensation in the leg receiving ropivacaine plus dexmedetomidine was 22 h (95% CI, 21 to 24) compared to 20 h (95% CI, 19 to 21) in the leg receiving ropivacaine plus placebo with a mean difference of 2 h (95% CI, 1 to 3; P = 0.001). The duration of block was also significantly longer in the leg receiving dexmedetomidine when assessed by pinprick, pain during tonic heat stimulation, and warmth detection threshold but not heat pain detection threshold. One participant experienced numbness in an area in the leg receiving dexmedetomidine.
  
  
  
  Dexmedetomidine prolongs the duration of a saphenous nerve block by a peripheral mechanism when controlling for systemic effects but not necessarily to a clinically relevant extent.
authors: From the Department of Anesthesiology, Zealand University Hospital, Køge, Denmark (J.H.A., O.M.); Department of Anesthesiology, Gentofte Hospital Kildegaardsvej Hellerup, Denmark (U.G.); Department of Anesthesiology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark (H.S.); Department of Anesthesiology, Bispebjerg Hospital, Copenhagen NV, Denmark (J.B.D.); and Department of Anesthesiology, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen East, Denmark (P.J.).
authors: Jakob H
authors: JH
authors: Andersen
authors: Ulrik
authors: U
authors: Grevstad
authors: Hanna
authors: H
authors: Siegel
authors: Jørgen B
authors: JB
authors: Dahl
authors: Ole
authors: O
authors: Mathiesen
authors: Pia
authors: P
authors: Jæger
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology*; D000328:Adult; D000577:Amides / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000494:pharmacology*; D020927:Dexmedetomidine / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010525:Peripheral Nerves / Q000187:drug effects*; D012016:Reference Values; D000077212:Ropivacaine; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000577:Amides; D000779:Anesthetics, Local; D020927:Dexmedetomidine; D000077212:Ropivacaine