Sixty-six patients undergoing anterolateral thigh free flap transfer for hand trauma were randomized to receive either intermittent 1.0 mg/mL dexmedetomidine + 0.125% ropivacaine (n=29) or 0.2% ropivacaine alone (n=31) via continuous infraclavicular brachial plexus block. The primary outcome was flap blood flow parameters, including peak systolic and diastolic velocities, resistance index, and arterial diameter. Secondary outcomes included patient satisfaction, hand numbness, motor block scores, VAS pain scores, and parecoxib-Na consumption. Outcomes were assessed at 0, 12, 24, and 48 hours postoperatively. Overall, the results revealed no significant difference in flap blood flow between groups, but the dexmedetomidine group reported significantly greater satisfaction, with less numbness and motor block. The study concludes that dexmedetomidine combined with lower concentration ropivacaine provides comparable analgesia with improved patient satisfaction and no detrimental effects on flap perfusion.