Perineural versus intravenous dexmedetomidine as an adjuvant for ilioinguinal/iliohypogastric nerve block in open inguinal hernia repair: a randomised controlled trial
In brief
Perineural dexmedetomidine cuts movement pain after hernia repair by 12 points
In a 90-patient trial, adding dexmedetomidine to the nerve block lowered movement-related pain at 6 hours by about 12 points on a 100-point scale versus placebo, reaching the study's threshold for a clinically meaningful difference. Intravenous dexmedetomidine did not improve pain and caused more bradycardia; pain was low overall, and time to first opioid was similar.
- Journal
- Hernia : the journal of hernias and abdominal wall surgery (Q1)
- Published
- 14 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Pinyada Pisutchareonpong, Chanyaphak Chumthong, Nattanicha Sirimanakul, Nutnicha Paenee, Pichchaporn Praserdvigai, Piyasak Vitayaburananont, et al.
- PMID
- 42873284
- DOI
- 10.1007/s10029-026-03866-6
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 16 October 2026): RCT of perineural vs IV dexmedetomidine for nerve block
Abstract
PURPOSE: Dexmedetomidine is widely added to peripheral nerve blocks, but whether the perineural or intravenous route provides better analgesia-and at what haemodynamic cost-is unclear in inguinal hernia repair. We compared the two routes as adjuncts to an ilioinguinal/iliohypogastric (II/IH) nerve block. METHODS: This single-centre, triple-blind randomised controlled trial enrolled 90 adults (ASA I-III) undergoing elective open inguinal hernia repair. All received an ultrasound-guided II/IH block (0.5% bupivacaine with epinephrine, 20 mL) and standardised tumescent local anaesthesia, and were randomised 1:1:1 to perineural dexmedetomidine 1 µg/kg (DexLA), intravenous dexmedetomidine 1 µg/kg over 10 min (DexIV), or placebo (Control). The primary outcome was movement-evoked visual analogue scale (VAS, 0-100) pain at 6 h, analysed by intention-to-treat. RESULTS: Movement VAS at 6 h was lower with perineural dexmedetomidine (DexLA 10.3 ± 10.3) than DexIV (20.0 ± 17.4) or Control (22.0 ± 20.6; overall p = 0.018): DexLA versus Control - 11.7 (95% CI - 21.9 to - 1.4; p = 0.022), whereas DexIV did not differ from Control (p = 0.888). This reduction reached the established minimum clinically important difference of approximately 10 points, although pain was low overall. Time to first opioid was similar (p = 0.723). Bradycardia was more frequent with DexIV (20.0%) than DexLA (3.3%) or Control (6.7%; DexIV vs DexLA p = 0.040); hypotension occurred in 43.3%, 40.0% and 20.0% (p = 0.151). CONCLUSION: Perineural-but not intravenous-dexmedetomidine produced a clinically relevant reduction in early movement-evoked pain, whereas intravenous dexmedetomidine added bradycardia without analgesic benefit. If dexmedetomidine is used in this setting, the perineural route is preferable. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20220208002; registered 7 February 2022.
Abstract as published, via PubMed.
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