Abstract: Background: Supraclavicular brachial plexus block provides effective anesthesia and postoperative analgesia for upper limb surgeries. Various intravenous adjuvants have been evaluated to enhance the quality and duration of analgesia. Dexmedetomidine and dexamethasone, when administered intravenously, have shown promising analgesic effects; however, comparative evidence remains limited.
Methods: This prospective comparative study was conducted on 80 patients (ASA physical status I-II), aged 18-60 years, undergoing elective unilateral upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Patients were randomized into two equal groups (n = 40 each). Group DEXA received intravenous dexamethasone 0.1 mg/kg, Group DEXMED received intravenous dexmedetomidine 1 µg/kg. All patients received 20 mL of 0.5% ropivacaine for the block. The primary outcome was time to first rescue analgesia. Secondary outcomes included onset and duration of sensory and motor block, postoperative VAS scores, intra-operative hemodynamic parameters, and adverse effects. Results: Demographic variables and baseline characteristics were comparable between groups.
The onset of sensory block was 10.02±1.16 minutes in Group DEXA and 10.45±1.26 minutes in Group DEXMED (p = 0.121), while onset of motor block was 15.35±1.21 minutes and 15.40±1.24 minutes, respectively (p = 0.855).
The duration of sensory block was 443.12±53.73 minutes in Group DEXA and 433.62±51.09 minutes in Group DEXMED (p = 0.422). Motor block duration was 392.25±57.45 minutes and 378.62±52.99 minutes, respectively (p = 0.274). The time to first rescue analgesia was significantly longer in Group DEXA (504.12±55.81 minutes) compared to Group DEXMED (496.25±47.78 minutes, p = 0.046).
Postoperative VAS scores were comparable between groups, with no pain reported up to 4 hours, mild pain at 6 hours in all patients, and severe pain at 12 hours in 10.0% (DEXA) and 12.5% (DEXMED) of patients. Intra-operative heart rate showed a statistically significant reduction in the DEXMED group at 5, 15, and 20 minutes; however, systolic blood pressure, diastolic blood pressure, and SpO2 remained comparable between groups. Adverse effects were minimal, with bradycardia and hypotension observed only in the DEXMED group, without statistical significance.
Conclusion: Both intravenous dexamethasone and dexmedetomidine are effective adjuvants for supraclavicular brachial plexus block. Intravenous dexamethasone provided a significantly longer duration of postoperative analgesia, while dexmedetomidine was associated with greater intra-operative heart rate reduction but maintained overall hemodynamic stability.
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