Background Peripheral nerve blockade is increasingly used in upper limb orthopedic surgery to provide effective anesthesia and prolonged postoperative analgesia while reducing systemic opioid requirements. Ultrasound-guided infraclavicular brachial plexus block provides reliable anesthesia for surgeries of the elbow, forearm, wrist, and hand, and adjuvants are frequently added to local anesthetics to improve block quality and prolong analgesia. Dexmedetomidine and fentanyl are two such adjuvants, but their comparative effects on onset, duration, and quality of blockade remain unclear. This observational study compared dexmedetomidine and fentanyl as adjuvants to ropivacaine in ultrasound-guided infraclavicular brachial plexus block. Methodology A prospective observational study was conducted in the Department of Anaesthesiology, Adichunchanagiri Institute of Medical Sciences, over 18 months from November 2016 to April 2018. Sixty eligible patients aged 18 to 65 years, of ASA physical status I or II, undergoing elective upper limb orthopedic surgery under ultrasound-guided infraclavicular brachial plexus block were enrolled consecutively and observed across two exposure groups of 30 each, categorized according to the adjuvant selected by the treating anesthesiologist as part of routine clinical practice. Group A received ropivacaine 0.75% (30 mL) with dexmedetomidine 50 micrograms, while Group B received ropivacaine 0.75% (30 mL) with fentanyl 75 micrograms, under ultrasound guidance. Sensory blockade was assessed by the pinprick method and motor blockade by the modified Bromage scale. Heart rate, blood pressure, and oxygen saturation were monitored, and adverse effects were recorded. Results Baseline demographic and clinical characteristics were comparable between the two groups, except mean body weight, which was lower in Group A. The mean onset of sensory blockade was 8.45 minutes in Group A compared with 1.83 minutes in Group B, and the mean onset of motor blockade was 11.27 minutes versus 2.87 minutes, both p<0.0001. Complete sensory blockade was attained at 12.90 minutes in Group A versus 5.90 minutes in Group B, and complete motor blockade at 20.12 minutes versus 7.06 minutes, both p<0.0001. Duration of sensory blockade was 883.17 minutes (SD 66.27) in Group A versus 404.00 minutes (SD 95.85) in Group B, and duration of motor blockade was 819.07 minutes versus 380.38 minutes, both p<0.0001. Postoperative analgesia lasted 977.79 minutes (SD 66.90) in Group A compared with 492.66 minutes (SD 106.14) in Group B, p<0.0001. Complete motor blockade was achieved in 24 patients (80%) in Group A versus 16 patients (53.33%) in Group B, p=0.0285. Systolic blood pressure was significantly higher in Group B from five minutes onward, while diastolic pressure was consistently higher in Group A. No hypotension, bradycardia, or respiratory depression was recorded in either group. Conclusion Dexmedetomidine, when added to 0.75% ropivacaine for ultrasound-guided infraclavicular brachial plexus block, was associated with a significantly longer duration of sensory and motor blockade and postoperative analgesia, along with denser motor blockade, compared with fentanyl, despite a slower onset. Fentanyl was associated with a faster onset of blockade. Both adjuvants demonstrated a favorable safety profile, favoring dexmedetomidine when prolonged analgesia is clinically prioritized.

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.

Background and objective While quality of recovery (QoR) has been studied in breast cancer surgeries using opioid-free anesthesia (OFA), it has not been assessed as a primary outcome in gynecological cancer surgeries. This study aimed to evaluate QoR using the QoR-40 score in gynecological cancer surgeries, comparing OFA with opioid-based anesthesia (OBA). Secondary outcomes included pain scores, requirement for rescue analgesia, postoperative nausea and vomiting (PONV), hemodynamic parameters, time to first ambulation, DN-4 scores, and length of hospital stay. Methods After obtaining Institutional Ethics Committee (IEC) approval and registration with the Clinical Trials Registry-India (CTRI), the study enrolled American Society of Anesthesiologists Physical Status (ASA-PS) I-II patients aged 20-65 years undergoing exploratory laparotomy for gynecological cancer. Exclusion criteria included chronic pain, a history of PONV, allergy to local anesthetics, coagulopathy, opioid use, or cognitive dysfunction. Group OF received dexmedetomidine and ketamine infusions, whereas group OB received IV morphine. All patients underwent epidural catheter placement and general anesthesia according to the study protocol, with epidural analgesia continued for 48 hours. The aforementioned secondary outcomes were recorded at 12 hours and on postoperative days one, two, and three. Results Eighty patients were enrolled in the study, with 40 patients in each group and comparable demographics. QoR was significantly better with OFA than with OBA. PONV was significantly lower in the OFA group for up to eight hours postoperatively. No significant differences were found in Numerical Rating Scale (NRS)-Pain scores, rescue analgesic use, time to ambulation, oral fluid tolerance, or hospital stay. Conclusions OFA significantly improved postoperative QoR and analgesia, and reduced PONV in patients undergoing gynecological cancer surgery, while intraoperative and postoperative hemodynamics, ambulation, oral fluid tolerance, and hospital stay remained comparable between groups.

Becker muscular dystrophy (BMD) is a rare X-linked dystrophinopathy caused by dystrophin gene (DMD gene) variants, resulting in reduced or dysfunctional dystrophin. Despite a milder course than Duchenne muscular dystrophy, patients face significant perioperative risk from skeletal muscle degeneration, respiratory weakness, cardiomyopathy, and conduction abnormalities. Succinylcholine and volatile anesthetics have been associated with life-threatening hyperkalemia, rhabdomyolysis, and malignant hyperthermia-like reactions in dystrophinopathies. Clinically manifest BMD in females is exceptionally rare due to skewed X-inactivation, and perioperative data in this population remain scarce. We report a 39-year-old woman with genetically confirmed, clinically manifested BMD who underwent elective left salpingo-oophorectomy with surgical staging for a large adnexal mass. She had severe proximal weakness and was non-ambulatory but had no respiratory, swallowing, or aspiration symptoms. Multidisciplinary preoperative evaluation (neurology, cardiology, hepatology, anesthesiology, gynecologic oncology, intensive care) confirmed preserved cardiac function (ejection fraction >70%), normal conduction, no respiratory compromise evidenced by normal pulmonary function tests, and adequate hepatic reserve. A trigger-free anesthetic strategy was used: the workstation was prepared to eliminate residual volatile agents, and total intravenous anesthesia was maintained with propofol, dexmedetomidine, and midazolam, avoiding succinylcholine and volatile agents. Reduced-dose atracurium provided neuromuscular blockade, and multimodal opioid-sparing analgesia included bilateral rectus sheath blocks and non-opioid analgesics. Surgery was uneventful, with no hemodynamic instability, arrhythmias, hyperkalemia, or rhabdomyolysis. The patient was extubated in the operating room after full neuromuscular recovery, then electively admitted to the ICU for observation given the risk of delayed respiratory compromise. Her postoperative course was uncomplicated, with stable cardiorespiratory function and effective analgesia. Histopathology confirmed an adult granulosa cell tumor of the ovary. This case suggests that major gynecologic surgery can be safely performed in clinically manifest female BMD patients through multidisciplinary planning, trigger-free total intravenous anesthesia, careful neuromuscular blockade, opioid-sparing analgesia, and planned ICU surveillance, offering valuable guidance for this rare, high-risk population.