Clinical Therapeutics/Volume 39, Number 1, 2017

Dexmedetomidine Added to Local Anesthetic

Mixture of Lidocaine and Ropivacaine Enhances
Onset and Prolongs Duration of a Popliteal
Approach to Sciatic Nerve Blockade
Xiawei Hu, MD1,2; Jinlei Li, MD, PhD, Msc3; Riyong Zhou, MD1;
Quanguang Wang, MD1; Fangfang Xia, MD1; Thomas Halaszynski, MD, PhD, MBA3;
and Xuzhong Xu, MD1
1
Department of Anaesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China;
2
Department of Anaesthesiology, Wenzhou People’s Hospital, Zhejiang, China; and 3Department of
Anaesthesiology, Yale New Haven Hospital, Yale University, New Haven, Connecticut

ABSTRACT groups (P 4 0.05). Motor onset of tibial nerve and

Purpose: A literature review of multiple clinical
studies on mixing additives to improve pharmacologic
limitation of local anesthetics during peripheral nerve
blockade revealed inconsistency in success rates and
various adverse effects. Animal research on dexmede-
tomidine as an adjuvant on the other hand has
promising results, with evidence of minimum un-
wanted results. This randomized, double-blinded,
contrastable observational study examined the effi-
cacy of adding dexmedetomidine to a mixture of
lidocaine plus ropivacaine during popliteal sciatic
nerve blockade (PSNB).
Methods: Sixty patients undergoing varicose saphe-
nous vein resection using ultrasonography-guided
PSNB along with femoral and obturator nerve blocks
as surgical anesthesia were enrolled. All received stand-
ardized femoral and obturator nerve blocks, and the
PSNB group was randomized to receive either 0.5 mL
(50 mg) of dexmedetomidine (DL group) or 0.5 mL of
saline (SL group) together with 2% lidocaine (9.5 mL)
plus 0.75% ropovacaine (10 mL). Sensory onset and
duration of lateral sural cutaneous nerve, sural nerve,
superficial peroneal nerve, deep peroneal nerve, lateral
plantar nerve, and medial plantar nerve were recorded.
Motor onset and duration of tibial nerve and common
peroneal nerve were also examined.
Findings: Sensory onset of sural nerve, superficial
peroneal nerve, lateral plantar nerve, and medial
plantar nerve was significantly quicker in the DL
group than in the SL group (P o 0.05). Sensory onset
of lateral sural cutaneous nerve and deep peroneal
nerve was not statistically different between the
common peroneal nerve was faster in the DL group
than in in the SL group (P o 0.05). Duration of both
sensory and motor blockade was significantly longer
in the DL group than in the SL group (P o 0.05).
Implications: Perineural dexmedetomidine added to
lidocaine and ropivacaine enhanced efficacy of popli-
teal approach to sciatic nerve blockade with faster
onset and longer duration. (Clin Ther. 2017;39:89–97)
& 2017 Elsevier HS Journals, Inc. All rights reserved.
Key words: adjuvant, adrenergic α2-receptor ago-
nists, dexmedetomidine, peripheral nerve blockade,
sciatic nerve, ultrasonography.
INTRODUCTION
Pain medicine parameters for lower-extremity surgery
using sciatic, femoral, and obturator nerve blockade
have proven effective1,2 and provide added value for
patients with severe cardiovascular and/or respiratory
disease(s).3,4 However, pharmacology and duration of
current long-acting local anesthetics (LAs) used during
regional anesthesia can limit blockade effectiveness.
Adding various adjuvant(s) to LAs during regional
anesthesia to enhance peripheral nerve blockade
(PNB) has been previously investigated and found to
have varying degrees of efficacy.5,6
Accepted for publication November 7, 2016.
http://dx.doi.org/10.1016/j.clinthera.2016.11.011
0149-2918/$ - see front matter
& 2017 Elsevier HS Journals, Inc. All rights reserved.

January 2017 89
 Clinical Therapeutics
Dexmedetomidine7,8 is a selective α2-adrenoceptor
agonist with sympatholytic, sedative, amnestic, and
analgesic properties. In recent years, as an adjuvant to
LAs during PNB, it has been investigated and found
effective in both clinical studies9 and animal models.10,11
Esmaoglu et al12 found advantages in the quality of the
block (shortened onset time and extended duration) in
their axillary brachial plexus that was formed with
dexmedetomidine as an adjuvant to levobupivacaine.
Brummett et al11 reported that adding dexmedetomidine
to ropivacaine caused an approximately 75% increase
in the duration of analgesia in rats. However, these
investigations have often been confined to single ter-
minal nerve branches (ulnar nerve13) or upper extremity
brachial plexus blockade.12 This randomized, double-
blinded, contrastable observational study was designed
to examine the effects of dexmedetomidine as an adju-
vant to LAs (mixture of lidocaine and ropivacaine) on
sensory and motor onset and duration of popliteal
sciatic nerve blockade (PSNB).
PATIENTS AND METHODS
Patient Demographic Characteristics
Informed consent was obtained from 60 patients
enrolled in a clinical trial receiving regional anesthesia
for unilateral varicose saphenous vein resection and
high ligation. All received ultrasonography-guided fem-
oral, obturator nerve block and groin skin infiltration.
In addition, patients were randomized to receive PSNB
with 0.5 mL (50 mg12–14) of dexmedetomidine (DL
group) (lot No. 13071034, Jiangsu Hengrui Medi-
cine Co Ltd, Lianyungang, China); or 0.5 mL of saline
(SL group) mixed with preservative-free 2% lidocaine
(9.5 mL) and 0.75% ropivacaine (10 mL). This study
received ethics committee approval from the First
Affiliated Hospital of Wenzhou Medical University,
Zhejiang Province, China February 21, 2014, and was
identified as trial ChiCTR-TRC-14004592 in the Chi-
nese Clinical Trial Registry on April 30, 2014.
Using a table of random numbers, a dedicated
nurse anesthetist selected a random number from 1
to 60 for each patient and recorded each patient
identification data, including corresponding natural
number, hospital number, and hospital name. Odd
and even numbers were then defined as group A and B,
respectively, corresponding to the DL and SL groups
with either 50 mg of dexmedetomidine or 0.5 mL of
saline mixed with lidocaine and ropivacaine,
90
respectively. The same nurse anesthesiologist prepared
LAs with labels, including the patient’s name and
hospital number, and was not involved in any direct
patient contact, block placement, or assessment. The
block anesthetist and examiners were masked to LA
adjuvant mixtures being administered as well. Patient
demographic characteristics are given in Table I.
The American Society of Anesthesiologists standard
monitors (pulse oximetry, electrocardiography, non-
invasive blood pressure, and respiratory rate) were
used. For sedation, each patient received IV midazo-
lam (1 mg) and fentanyl (20 mg) before block place-
ment. Exclusion criteria were defined as patient
refusal, diabetes, allergy to LAs or dexmedetomidine,
preexisting neurologic or neuromuscular disease, in-
fection at intended injection site, psychiatric disorders
or those unlikely to cooperate during the study,
patients treated with α2-adrenoceptor agonist, preg-
nant patients, and those younger than 18 years.
Ultrasonography-guided PSNB and Femoral and
Obturator Nerve Block Technique
Patients were positioned in lateral decubitus posi-
tion after standard skin preparation with povidone-
iodine (lot No. Q/JKL 005-2010, Hangzhou Xinpu
Biological Technology Co Ltd, Hangzhou City,
China). The sciatic nerve in the popliteal fossa was
identified by ultrasonography (Edge, Sonosite, Bothell,
Washington) using a linear array 6 to 15-MHz ultra-
sonography probe and imaged along its course to a
position where the tibial nerve and common peroneal
nerve converge. After LA skin infiltration, a 21-G
short-bevel insulated needle (0.7
80 thin wall long
bevel (TWLB), Kangdelai Medical Instrument Co Ltd,
Yuhuan, China) was advanced under a short axis view
of the target using an in-plane needling approach.
With direct ultrasonographic visualization, the LA
mixture was deposited (total volume of 20 mL) below
and above the sciatic nerve where the tibial nerve and
common peroneal nerve unite (inside the facial plane
of the common paraneural sheath15). The LA volume
was injected in 5-mL aliquots with intermittent con-
firmation of negative blood aspiration.
Ultrasonography-guided femoral and obturator
nerve blocks were then performed with patients in
the supine position according to approaches des-
cribed by Szűcs et al16 and Taha.17 LA solutions of
preservative-free 2% lidocaine and 0.75% ropivacaine
(1:1 ratio) were injected using10 mL for the femoral
Volume 39 Number 1

Table I. Pertinent demographic characteristics of the 30 study patients.
Characteristic DL Group
Age, mean (SD), y 56 (11)
Height, mean (SD), cm 165 (8)
Weight, mean (SD), kg 65 (9)
BMI, kg/m2 24 (3)
BMI ¼ body mass index; DL ¼ dexmedetomidine; SL ¼ saline.
nerve, 5 mL for the obturator nerve, and infiltration of
5 mL along inguinal crease corresponding to the
femoral vein (confirmation by ultrasonography).
Assessment of Sensory and Motor Blockade
Sensory and motor block onset and duration of the
PSNB were evaluated by data collector(s) as follows.
First, baseline assessment was performed before block
placement. Second, sensory and motor block onset
was assessed at 2-minute increments beginning 2
minutes after block placement up to 20 minutes, then
again at 25 and 30 minutes after PSNB. PSNB sensory
or motor onset requiring 430 minutes was deter-
mined as a failed block. Third, sensory and motor
block duration was assessed at the end of surgery and
then at 2, 4, 6, 8, and 24 hours to avoid disturbing
patients’ sleep in wards after surgery. Evaluating
sensory and motor block duration was performed by
asking the following questions: “What time did you
start to feel sensation return in the foot,” “What time
did you start to have pain in the foot,” and “What
time could you move your toes on the surgical side?”
Fourth, 50 mg of indomethacin was prepared for
rectal administration if the patients needed supple-
mental analgesia in wards.
Sensory assessment of PSNB was performed in
6 areas of the lower extremity defined and shown in
the Figure using pinprick testing (contralateral
extremity as a control), with 1 indicating sharp
(same as the contralateral leg and foot); 2, touch
(pinprick perceived as pressure); and 3, absent
(complete loss of pinprick awareness). Complete
sensory onset time was defined as the end of LA
injection to complete absence of pinprick sensation
and sensory duration as the time from end of injection
to full return of sensation or first pain symptom.
January 2017
X. Hu et al.
SL Group P
57 (13) 0.889
164 (6) 0.310
66 (6) 0.692
25 (2) 0.221
Motor blockade was assessed using a 3-point
scoring system, with 0 indicating 5/5 or normal
muscle power; 1, 2 to 4/5 or reduced muscle power
(plantar or dorsiflexion); and 2, 0/5 or complete
motor block (plantar and dorsal flexion). PSNB motor
onset and duration were identified as follows: motor
onset from the end of LA injection to complete motor
blockade (2 points) and motor block duration from
the end of injection to complete return to baseline
motor strength (0 points).
Evaluation of Surgical Anesthesia
Quality of surgical anesthesia was assessed and
categorized into 1 of 3 levels as follows: 1, excellent
(complete surgical anesthesia without need for any
supplemental medications); 2, good to intermediate
(mild discomfort requiring small amounts of rescue
analgesics, eg, routine rescue strategy was intravenous
midazolam and fentanyl); and 3, poor (block failure
requiring conversion to general anesthesia).
Sedation Score
Maximum level of sedation 30 minutes after PNB
was evaluated using the Ramsay score,18 where o2
points indicates inadequate sedation, 2 to 4 points
represents satisfactory sedation, and 44 points
identifies excessive sedation as follows: 1, awake,
anxious, agitated, restless, or all of the above; 2,
awake, cooperative, orientated, and tranquil; 3,
awake but responds to commands only; 4¼, sleep
but brisk awakening by response to light glabellar tap
or loud auditory stimulus; 5, asleep and sluggish
response to light glabellar tap or loud auditory
stimulus; and 6, asleep with no response to light
glabellar tap or loud auditory stimulus.
91
 Clinical Therapeutics

genitocrural nerve

inguinal nerve

lateral femoral
cutaneous nerve
obturator nerve
medial plantar nerve

lateral plantar nerve

femoral nerve

lateral sural
cutaneous nerve

saphenous nerve

superficial peroneal nerve

sural nerve
deep perineal nerve

Figure. Sensory distribution of sciatic nerve branches, femoral nerve, and obturator nerve. The white dots
indicate the pinprick test points.

Assessment of Satisfaction 10% (α ¼ 0.05, β ¼ 0.1) requires a sample size of 28

Patient satisfaction with the regional anesthesia in
wards postoperatively was assessed using the following
5-point scale19 by asking question, “How satisfied were
you with the anesthesia?”: 0, extremely dissatisfied; 1,
dissatisfied; 2, neutral (neither satisfied nor dissatisfied);
3, satisfied; and 4, completely satisfied.
Monitoring for Evidence of Adverse Effects
Commonly observed adverse effects7 from dexme-
detomidine administration are excessive sedation (1 to
6 as defined above), respiratory depression (respiratory
rate o10 breaths/min), nausea, vomiting, hypotension
(mean arterial pressure 420% decrease from baseline),
and bradycardia (heart rate o50 beats/min). Atropine
and ephedrine were prepared and administered if need-
ed for treatment of hypotension and/or bradycardia.
Statistical Analysis
An initial pilot trial of superficial peroneal nerve
sensory block onset using 5 patients in each group
revealed a mean (SD) of 8.6 (3.5) min in the DL group
and 12.2 (4.5) min in the SL group. Therefore,
a 2-tailed type I error of 5% and type II error of
patients per group by sample size [PASS] 11.0. In case
of potential dropouts, 30 patients per group were
recruited. In case of potential dropouts, 30 patients
per group were recruited.
Statistical analysis was performed using SPSS stat-
istical software, version 11.0 (SPSS Inc, Chicago,
Illinois). An independent 2-sample t test was used
for variables with normal distribution, which included
onset time and duration of PSNB sensory and motor
blockade. Quality of PSNB surgical anesthesia and
sedation scores were analyzed using the rank sum test.
All data are presented as mean (SD), and P o 0.05
was considered statistically significant.
RESULTS
All patients enrolled in this investigation completed
the study. Both groups (DL and SL) had comparable
demographic characteristics with equal numbers of
males and females, similar ages ranging from 30 to 80
years, and comparable patient height and weight
characteristics (P 4 0.05) (Table I).
PSNB sensory onset times for sural nerve (P ¼
0.031), superficial peroneal nerve (P o 0.001), lateral

92 Volume 39 Number 1
 X. Hu et al.

Table II. Block characteristics of the 30 study patients.

Characteristic DL Group, Mean (SD) SL Group, Mean (SD) P

Sensory onset time, min

Lateral sural cutaneous 1.5 (0.3) 1.7 (0.5) 0.236
Sural nerve 3.1 (1.1) 3.9 (1.6) 0.031
Superficial peroneal nerve 4.9 (1.5) 8.2 (1.9) o0.001
Profundum peroneal nerve 9.0 (4.1) 10.0 (2.3) 0.195
Lateral plantar nerve 6.5 (2.7) 11.6 (3.7) o0.001
Medial plantar nerve 10.9 (2.7) 13.2 (3.3) 0.004
Motor onset time, min
Tibial nerve 10.5 (2.4) 14.0 (3.5) o0.001
Common peroneal nerve 9.9 (2.8) 13.6 (3.8) o0.001
Duration of sensory block, min 935 (206) 758 (114) o0.001
Duration of motor block, min 917 (193) 708 (172) o0.001

plantar nerve (P o 0.001), and medial plantar nerve
(P ¼ 0.004) were shorter in the DL group than those
in the SL group. Sensory onset times of lateral sural
cutaneous nerve (LSCN) (P ¼ 0.236) and deep
peroneal nerve (DPN) (P ¼ 0.195) were not statisti-
cally different between groups. PSNB time to motor
onset of the tibial nerve (P o 0.001) and the common
peroneal nerve (P o 0.001) in the DL group were
shorter than in the SL group. Duration of PSNB
sensory (P o 0.001) and motor (P o 0.001) block
were longer in the DL group than in the SL group of
all nerves tested (Table II).
Quality of surgical anesthesia in the DL group was
rated as excellent in 14 of 30 patients and as good to
intermediate in remaining the 16 patients compared
with the SL group, in which 10 of 30 patients rated
surgical anesthesia as excellent and the remaining
20 as good to intermediate surgical anesthesia. There
were no failed blocks and little differences in sur-
gical anesthesia ratings between groups (P ¼ 0.021)
(Table III).
There were statistical differences in sedation level
between groups with maximum levels of sedation at
30 minutes after PSNB reported as 2 points in 10
patients, 3 points in 19 patients, and 4 points in 1
patient from the DL group compared with 2 points in
28 patients and 3 points in 2 patients from the SL
group (P o 0.001) (Table III).
There were no statistical differences in patient
satisfaction with the technique of regional anesthesia
between groups reported as 0 and 1 point in 0
patients, 2 points in 7 patients, 3 points in 16 patients,
and 4 points in 7 patients from the DL group
compared with 0 points in 0 patients, 1 point in 1
patient, 2 points in 5 patients, 3 points in 18 patients,
and 4 points in 6 patients from the SL group (P ¼
0.170) (Table III).
No PNB-associated or dexmedetomidine-related
adverse effects were reported. Excessive sedation,
respiratory depression, nausea, vomiting, hypoten-
sion, or bradycardia were observed in neither group
of patients. Postoperative clinical examination of
patients revealed no impairment of sensory or motor
function and no evidence or symptoms of nerve injury.
The only postoperative supplemental analgesics re-
quired was indomethacin in 50 mg by rectal admin-
istration in 2 patients in each group.
DISCUSSION
Because sciatic nerve is the largest peripheral nerve
(wrapped by multilayer fascia) within the human
body, it is anticipated that sciatic nerve blockade
would require longer onset time for the LA to
penetrate or diffuse toward target sodium channels
compared with smaller-gauge nerves.20,21 This con-
cept can create clinical concern about timing efficacy
of regional anesthesia during PSNB.22
Another more significant concern with regional
anesthesia is clinical limitation of PNB duration.
Duration of single-shot regional is limited by the
pharmacologic profile of the chosen anesthetic, and

January 2017 93
 Clinical Therapeutics

Table III. Anesthesia characteristics in the 30 study patients.

Characteristic DL Group, No. of Patients SL Group, No. of Patients

Quality of surgical anesthesia*

Excellent 14 10
Good to intermediate 16 20
Poor 0 0
Maximum sedation levels†
1 Point 0 0
2 Points 10 28
3 Points 19 2
4 Points 1 0
5 Points 0 0
6-points 0 0
Satisfaction‡
Extremely dissatisfied 0 0
Dissatisfied 0 1
Neutral 7 5
Satisfied 16 18
Completely satisfied 7 6

*
P ¼ 0.021.
†
P o 0.001.
‡
P ¼ 0.170.

achieving prolonged sensory blockade would provide
for longer analgesia and the avoidance of premature
return of moderate to severe pain states. A recent
systemic review and meta-analysis found that adding
dexmedetomidine as an adjuvant to a long-acting LA
during regional anesthesia revealed improved effects
of both neuraxial and PNB of small nerves and the
brachial plexus.9
Investigations examining perineural dexmedetomi-
dine mixed with LAs during PNB found extended
analgesia with evidence of limited adverse events.
These published studies were performed on small
peripheral nerves or blockade of the brachial plexus,
such as the study by Marhofer et al,13 which revealed
faster motor onset time with dexmedetomidine added
to ropivacaine (sensory onset time was not different)
along with profound prolongation of nerve blockade
from perineural dexmedetomidine, and the study by
Esmaoglu et al,12 which found that dexmedetomidine
combined with levobupivacaine shortened sensory and
motor block onset time and extended blockade duration
in axillary brachial plexus blockade. However,
continued concerns for any potential adverse effects
(hemodynamics compromise and excessive or increased
sedation), lack of dose response evidence, full
understanding on mechanism(s) of action, and safety
data require further investigation.
Definitive studies describing clinical consequences
of dose-response data on dexmedetomidine used dur-
ing PNB are lacking. Esmaoglu et al12 reported
incidence of hypotension and bradycardia to be
higher in patients receiving 100 mg of dexmedeto-
midine mixed with an LA during an axillary brachial
plexus block compared with the control group.
A volunteer study by Marhofer et al13 reported that
hypotension and bradycardia was not evident using
20 mg of dexmedetomidine as an adjuvant to
ropivacaine during PNB of the ulnar nerve. Ammar
et al14 also reported no hemodynamic variability and
absence of adverse effects using 0.75 mg/kg of
dexmedetomidine combined with an LA during an
infraclavicular approach to the brachial plexus. The
dose of dexmedetomidine used in this study was
chosen because of reports of minimal influence on

94 Volume 39 Number 1

hemodynamics and sedation and because a 50-mg dose
proved appropriate for the mean weight of patients
used in this investigation (0.75 mg
65 kg).
Therefore, 50 mg of dexmedetomidine added to
equal volumes of 0.75% ropivacaine (long-acting
LA) and 2% lidocaine (quick-onset LA) was
investigated to assess PNB characteristics during a
popliteal approach to the sciatic nerve, including
sensory and motor onset times, PNB duration of
effect, and examination for evidence of adverse effects.
This investigation revealed that adding dexmede-
tomidine to a mixture of lidocaine and ropivacaine
accelerated onset times of all motor and most
sensory branches (exception for LSCN and DPN)
when performing a popliteal approach to sciatic
nerve blockade. Duration of sensory and motor
block of all branches examined from the PSNB
was also prolonged. Little differences in sensory
onset time of LSCN between the DL and SL groups
in this investigation can be partially explained by
anatomical location and size of nerve branch(LSCN
is small and branches off early [superficial position
in the popliteal fossa] from the CPN, and sensory
onset of small nerves with ultrasonography guid-
ance is already quite fast such that a large sample
size would be required to reveal any beneficial
effects from adding dexmedetomidine.) Similar to
the observation of fast sensory onset of the LSCN
(irrespective of a dexmedetomidine adjuvant),
Marhofer et al13 also reported a fast sensory onset
time of an ultrasonography-guided ulnar nerve
block, revealing no difference in the volunteers
regardless of whether dexmedetomidine was added
to the LA. This observation is described as an
advantage of performing PNB under ultrasonogra-
phy guidance accounting for reduced onset times
attributable to more optimal LA spread in relation
to target nerves.
Mechanisms for limited difference in onset time of
DPN are explained as follows: (1) concentration of
dexmedetomidine (50 mg/20 mL) in this study was
lower than reported in the literature (50 mg/5 mL); (b)
anatomical variations in the course of DPN from
origin to terminal branches could have mitigated any
small block onset benefits offered by low-dose and
low-concentration of dexmedetomidine; and (3) cuta-
neous branch of DPN supplies a narrow area on
dorsal surface of the foot that may be too narrow to
be assessed accurately by pinprick.
January 2017
X. Hu et al.
In our study, we found a significant difference in
maximum sedation levels at 30 minutes after PSNB
between the DL and SL groups, but no respiratory
depression was observed with 50 mg of dexmedetomi-
dine. Dexmedetomidine is a potent and highly selec-
tive α2-adrenoceptor agonist, and agonism at the
α2 - a receptor appeared to promote sedation. It
provides a unique conscious sedation (patients appear
to be asleep but are readily roused).7
Mechanisms by which dexmedetomidine added to
LA enhances PNB efficacy are not fully understood
but are likely to be multifactorial and have been
theorized as being conducted at the perineural level.
Sensory block duration of ultrasonography-guided
ulnar nerve blockade in volunteers receiving ropiva-
caine plus perineural dexmedetomidine was enhanced
compared with those performed with ropivacaine
perineurally plus dexmedetomidine systemically.13
Additional studies by Brummett et al11 conclu-
ded that perineural dexmedetomidine added to
ropivacaine for sciatic nerve blockade in rats proved
to prolong duration of analgesia by blocking the
hyperpolarization-activated cation current but not by
an α2-adrenoceptor antagonist. Centrally, α2 agonists
inhibit release of substance P in the nociceptive
pathway at the level of the dorsal root neuron
and by activation of α2-adrenoceptors in the locus
coeruleus.23
Study limitations included the following. First, the
study lacked grouping to evaluate dexmedetomidine
dose response in combination with an LA during the
popliteal approach to the sciatic nerve (chosen dose in
this study is likely accountable for nonsignificant
differences for sensory onset of LSCN and DPN).
Second, this investigation did not randomize to exam-
ine differences between systemic versus perineural
dexmedetomidine administration, and the reported
sedation level differences in this study make this an
important study topic in future investigations. On the
other hand, systemic absorption can explain only the
potential analgesic effect differences but not the major
outcome in this study (ie, sensory and/or motor
blockade effects). Third, the moderate size of this
study did not offer any capacity to assess for all
efficacy and safety parameters of perineural dexme-
detomidine administration. Fourth, dexmedetomidine
used in patients with comorbidities needs to be
investigated. In addition, examining for variable clin-
ical consequences, including block efficacy and side
95
 Clinical Therapeutics
effect profiles, when performing different peripheral
nerve or nerve plexus blockade with dexmedetomidine
mixed with an LA have not delineated in this study.
CONCLUSION
Significant improvement in regional anesthesia effi-
cacy during ultrasonography-guided PSNB using 50 mg
of dexmedetomidine (perineural injection) in combi-
nation with 0.75% ropivacaine and 2% lidocaine has
been found. Achieving quicker onset and longer
duration of PSNB can deliver both clinical and
economic benefits in optimal patient care. However,
future studies on perineural dexmedetomidine dose
response, efficacy, and safety profile while various
PNBs are performed are needed.
ACKNOWLEDGMENTS
X. Hu contributed to the literature search, study
design, conduct of the study, data collection, analyses,
and writing of the manuscript. J. Li contributed to the
study design and the writing of the manuscript.
R. Zhou and Q. Wang contributed to the conduct of
the study and data collection. F. Xia contributed to
the conduct of the study and Figure creation.
T. Halaszynski contributed to the writing of the
manuscript. X. Xu contributed to the literature
search, study design, data interpretation and writing
of the manuscript. All authors read and approved the
final manuscript.
FUNDING SOURCES
This project was supported by grant LY13HO90008
from the Natural Science Foundation of Zhejiang
Province, China, and grant Y20140326 from the
Wenzhou Science and Technology Bureau, Zhejiang
Province, China.
CONFLICTS OF INTEREST
The authors have indicated that they have no conflicts
of interest regarding the content of this article.
SUPPLEMENTARY MATERIAL
Supplementary data associated with this article can be
found in the online version at http://dx.doi.org/
10.1016/j.clinthera.2016.11.011.
96
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January 2017 97
 Clinical Therapeutics

SUPPLEMENTARY MATERIAL
Figure SI.

60 Patients

Computer Assisted Randomization

odd number even number

Group A Group B
(N = 30)
By a Nurse
(N = 30)
0.5mL (50mcg)
0.5mL saline
Dexmedetomidine
+
+
9.5mL Lidocaine
9.5mL Lidocaine
+
+
10mL Ropivacaine
10mL Ropivacaine

Ultrasound – guided popliteal sciatic nerve block By the Block

along with femoral and obturatornerve blocks Anaesthetist

By another
Experimental parametets assessment Anaesthetist

Flowchart.

97.e1 Volume 39 Number 1

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permission.