REGIONAL ANESTHESIA: Edited by Stephan C. KettnerSafety and efficiency of dexmedetomidine as adjuvant to local anestheticsMarhofer, Peter; Brummett, Chad M.Author Information aDepartment of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria bDivision of Pain Medicine, Department of Anesthesiology, The University of Michigan Medical School, Ann Arbor, Michigan, USA Correspondence to Peter Marhofer, MD, Professor of Anaesthesia and Intensive Care Medicine, Department of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria. Tel: +43 1 40400 22330; fax: +43 1 40400 40280; e-mail: [email protected] Current Opinion in Anaesthesiology: October 2016 - Volume 29 - Issue 5 - p 632-637 doi: 10.1097/ACO.0000000000000364 Buy Metrics Abstract Purpose of review To review the current knowledge of dexmedetomidine as an additive drug to local anesthetics in peripheral and neuraxial regional anesthesia. Recent findings Recent studies show a perineural mode of action of dexmedetomidine. Pharmacodynamic characteristics of peripheral and neuraxial regional anesthetic techniques are optimized by the addition of dexmedetomidine to long-acting local anesthetics. Bradycardia and sedation are the main systemic side-effects of dexmedetomidine for regional anesthesia purposes. A dose of approximately 100 μg dexmedetomidine for peripheral techniques may represent the optimal balance between optimization of block characteristics and side-effects. Doses between 3 and 10 μg are described to be sufficient for spinal administration. Summary Dexmedetomidine has a potency to ameliorate pharmacodynamic characteristics of peripheral and neuraxial regional anesthetic techniques and is therefore currently the most promising additive drug in regional anesthesia. Future scientific efforts should focus on dose finding studies for particular regional anesthetic techniques. Approval of dexmedetomidine for regional anesthetic indications should be the final target. Copyright © 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.