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We investigated whether perineural or intravenous dexmedetomidine (Dex) administration combined with anterior QLB could improve analgesic efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ninety-six patients were randomized, and 88 were included in the modified per-protocol analysis. A total of 88 patients scheduled for retroperitoneal laparoscopic surgery under general anesthesia combined with anterior QLB were randomly assigned to one of three groups: (1) control group (R): 0.375% ropivacaine 30 mL; (2) ropivacaine plus perineural Dex (RD): 0.375% ropivacaine 30 mL plus 1\u00a0\u00b5g\/kg Dex, (3) ropivacaine plus intravenous Dex (RDiv): 0.375% ropivacaine 30 mL plus intravenous 1\u00a0\u00b5g\/kg Dex. The primary outcome was the 48\u00a0h postoperative sufentanil consumption. Secondary outcomes included Numerical Rating Scale (NRS) scores at different postoperative time points, intraoperative hemodynamic parameters, and adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 48\u00a0h postoperative sufentanil consumption was significantly lower in group RD than in groups R and RDiv [median (IQR): 31.0 (16.3, 39.0) vs. 40.1 (27.2, 60.7) vs. 42.0 (31.5, 57.9); adjusted\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05, Bonferroni post-hoc test], with between-group differences of -17.2\u00a0\u00b5g (95%CI -23.4 to -11.3) and \u2212\u200916.7\u00a0\u00b5g (95%CI -23.2 to -10.8). Fewer patients in group RD (14% vs. 40% vs. 34%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.069) required rescue analgesia, though the difference did not reach statistical significance. Group RD exhibited significantly lower resting and dynamic NRS pain scores at key postoperative time points (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). QoR-15 was statistically higher in group RD, although the between-group difference was below the reported minimal clinically important difference (MCID). Dexmedetomidine was associated with lower MAP and HR at selected intraoperative time points, without a statistically significant increase in postoperative bradycardia or hypotension. No significant differences were observed among the three groups in adverse events, time to first flatus, ambulation, or length of stay( all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Perineural administration of 1\u00a0\u00b5g\/kg dexmedetomidine combined with anterior QLB could provide better postoperative analgesia, which reduced 48-hour postoperative sufentanil consumption and improved pain scores at several time points. However, intravenous dexmedetomidine at the same dose did not confer comparable benefits in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Chinese Clinical Trial Registry (ChiCTR2300074778) Registration date 16\/08\/2023.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-04103-4","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T13:24:07Z","timestamp":1784381047000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perineural or intravenous administration of dexmedetomidine combined with anterior quadratus lumborum block for analgesia after retroperitoneal laparoscopic surgery: a prospective, randomized controlled trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Yunru","family":"Jiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hengrui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyang","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxiang","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhibiao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumin","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijie","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"issue":"8","key":"4103_CR1","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1001\/jamasurg.2021.0586","volume":"156","author":"O Ljungqvist","year":"2021","unstructured":"Ljungqvist O, De Boer HD, Balfour A, et al. 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