Objective: To evaluate the combination of dexmedetomidine and ketamine for analgesic sedation. Design: Prospective randomised clinical study. Setting: Department of Anaesthesiology and Intensive Care, University Hospital. Materials and methods: Patients scheduled for Dupuytren’s contracture repair under local anaesthesia were randomly divided to groups C and D. Group D patients were administered an infusion of dexmedetomidine 1 μg . ml-1 and ketamine 1 mg . ml-1 in normal saline as follows: 10 minutes before surgery a bolus of 0.04 ml . kg-1 (e. g. dexmedetomidine 0.04 μg . kg-1, ketamine 0.04 mg . kg-1) was given, followed by infusion of 2 ml . kg-1. h-1 for the first 10 minutes (dexmedetomidine 2 μg . kg-1 . h-1, ketamine 2 mg . kg-1 . h-1) and 1 ml . kg-1 . h-1 (dexmedetomidine 1 μg . kg-1 . h-1, ketamine 1 mg . kg-1 . h.-1) for the rest of surgery. Group C patients were given normal saline. Vital functions, analgesia and Ramsay score were measured. Results: There were 7 patients in group C and 8 patients in group D. The demographic characteristics were comparable between the groups. We found differences between groups C and D in Ramsay score (all group C patients scored 1 point vs. 7 group D patients scored 2 points and one patient scored 3 points, p < 0.001), absence of reaction to painful application of local anaesthetic and tourniquet (0 vs. 6, p = 0.02), amnesia (0 vs. 6, p = 0.02) and light-headedness 1 hour after surgery (0 vs. 7, p = 0.005). Five patients in group D remembered dreams (NS). There was a slight fall in blood pressure (25–30% below base-line) in 4 patients in group D (NS) and no change in ventilation. Conclusions: The combination of dexmedetomidine and ketamine provides analgesia, amnesia and catatonia with preserved cooperation, and has no respiratory effects.

        Key words: analgesic sedation – dexmedetomidine – ketamine