Liposomal Bupivacaine With Standard Bupivacaine Versus Dexmedetomidine With Standard Bupivacaine

Exclusion Criteria

• •Revision surgery
• •Previous fractures or surgery in the affected distal radius
• •Surgery involving more than the affected arm
• •Higher energy and high-grade fracture cases - road traffic accident, fall from height, open fractures, combined distal radius and distal ulna fractures, fractures requiring external fixation, fractures with severe articular comminution or severe metaphyseal extension, comminuted fractures requiring more than a single volar approach incision and a single volar locking plate implant
• •Cases with painful conditions affecting the upper limb prior to surgery such as cervical spine, shoulder, elbow, other hand and wrist problems
• •Cases with baseline (pre-injury) QuickDASH score worse than 10 out of 100
• •Respiratory compromise (requires long term oxygen)
• •History of seizures
• •Pre-existing neurological disorder/deficit
• •Chronic opioid user (3 months or more)
• •Presence of chronic pain condition (pain duration over 3 months)
• •Alcohol or substance abuse
• •Psychiatric illness
• •Impaired mental state
• •Local infection
• •Allergy to analgesic drugs: local anaesthetic drugs, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids
• •Impaired renal function (defined as effective glomerular filtration rate \<30ml/min/1.73m2
• •Impaired liver function (defined as plasma bilirubin over 34μmol/L; international normalized ratio \[INR\] ≥1.7, alanine aminotransferase \[ALT\] over 100U/L, aspartate aminotransferase \[AST\] over 100U/L)
• •Coagulopathy (platelet count \<100,000/ml and/or INR ≥1.5) or the use of anticoagulants (not including aspirin) that precludes the use of supraclavicular BPB
• •Pregnancy
• •Patient refusal for regional nerve blocks
• •Patient refusal to join the clinical trial
• •Patient unable/unwilling to attend post-op rehabilitation programme