What is known and objective: The aim of this study was to elucidate the effect of dexmedetomidine added to ropivacaine on the onset and duration of sensory and motor block and duration of analgesia of ultrasound-guided axillary brachial plexus block.Methods: Thirty-seven ASA physical status I-II patients with elective forearm and hand surgery under ultrasound-guided axillary brachial plexus block were randomly divided into 2 groups. Patients in ropivacaine-dexmedetomidine group (group RD, n = 19) received 15 mL of 0.5% ropivacaine with 100 μg (1 mL) dexmedetomidine, and patients in ropivacaine group (group R, n = 18) received 15 mL of 0.5% ropivacaine with 1 mL of normal saline. Onset time and duration of sensory and motor block and duration of analgesia were assessed.Results and discussion: Duration of sensory block (U-value = 35, P < .001), duration of motor block (P = .001) and duration of analgesia (P < .001) were extended in group RD compared to group R. Onset time of sensory block in group RD was significantly faster than in group R (U-value = 65.5, P = .001). Onset time of motor block showed no significant difference between the 2 groups (U-value = 116.5, P = .096). Adverse reactions were reported only in group RD (bradycardia in 2 and hypotension in 3 patients). What is new and conclusion:Our study indicated that dexmedetomidine 100 μg as adjuvant on ultrasound-guided axillary plexus block significantly prolonged the duration of sensory block and analgesia, as well as accelerated the time to onset of sensory block. These results should be weighed against the increased risks of motor block prolongation, transient bradycardia and hypotension and allow for attentive optimism, only if prolonged clinical trials provide a definitive answer. K E Y W O R D S axillary brachial plexus block, dexmedetomidine, ropivacaine | WHAT IS KNOWN AND OBJECTIVEThe axillary brachial plexus block is widely used for orthopaedic surgery of the upper extremity as an alternative to general anaesthesia.It is relatively simple to perform and with the advent of ultrasound technology, and there is a marked improvement in success rate of anaesthesia. 1Regional anaesthesia with long-acting local anaesthetics (LAs), such as ropivacaine, is beneficial for effective postoperative pain control, but the duration of sensory block is still not sufficient to avoid | 349 KORAKI et Al.the postoperative use of opioids. Perineural catheters and continuous infusion are an effective alternative to prolong the analgesic effects, 2 but they can present challenges related to patient management, catheter displacement and the potential for increased infection risk. 3 On the other hand, the use of adjuvants, such as adrenaline, clonidine, opioid and steroids, with local anaesthetics for early onset and for prolonging the duration of blocks has been practiced for many years and remains the subject of much interest. 4Dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist that has an alpha-2 to alpha-1 selectivity ratio 7 times greater than tha...

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Although spinal anaesthesia has a more favourable riskprofile, patients usually prefer surgery under general anaesthesia. Besides fear of severe but rare neurological complications, typical reasons for rejection are fear of backache or anticipated pain during puncture. Providing local anaesthesia before lumbar puncture is not a standard procedure.

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