Background: Optimizing anesthesia in orthopedic surgeries is crucial for improving postoperative outcomes and patient satisfaction. Dexmedetomidine, a selective α2-adrenoceptor agonist, has been proposed as a beneficial adjunct to spinal anesthesia, offering sedative, analgesic, and hemodynamic stabilizing properties.

Methods: In this prospective comparative, 100 patients undergoing elective orthopedic surgeries were allocated to receive spinal anesthesia with either dexmedetomidine (Group D, n=50) or placebo (Group C, n=50). The study evaluated the duration of sensory and motor blockade, postoperative analgesic requirements, hemodynamic parameters, incidence of side effects, and patient satisfaction.

Results: The addition of dexmedetomidine significantly prolonged the duration of sensory (243.8 ± 35.4 vs. 192.6 ± 29.8 minutes, P<0.001) and motor blockade (196.5 ± 22.1 vs. 148.3 ± 25.6 minutes, P<0.001). Group D patients required less postoperative analgesics (134.2 ± 28.7 mg vs. 205.6 ± 33.5 mg, P<0.001) and reported a longer time to first analgesic request (14.7 ± 2.6 hr vs. 10.4 ± 2.1 hr, P<0.001). Despite an increased incidence of bradycardia and hypotension in Group D, these were clinically manageable. Patient satisfaction was significantly higher in the dexmedetomidine group (P=0.012).

Conclusion: Dexmedetomidine as an adjunct to spinal anesthesia in orthopedic surgeries significantly improves blockade duration, reduces postoperative analgesic needs, and enhances patient satisfaction, with manageable hemodynamic effects. These findings support the adjunctive use of dexmedetomidine, highlighting the importance of appropriate dosing and monitoring.