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Dexmedetomidine versus Dexamethasone as an Adjuvant to 0.5% Ropivacaine in Ultrasound-guided Infraclavicular Brachial Plexus Block: A Randomised Controlled Study
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DOI：10.7860/JCDR/2026/81527.22827.png)
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Abstract
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Introduction: Infraclavicular brachial plexus blocks provide effective surgical anaesthesia and postoperative analgesia for upper limb surgeries. The use of adjuvants with local anaesthetics has gained significant attention for enhancing block quality, prolonging the duration of analgesia, and reducing postoperative opioid requirements. Both dexmedetomidine and dexamethasone have emerged as promising adjuvants; however, their comparative efficacy in infraclavicular blocks remains under investigation. Aim: To compare the efficacy of dexmedetomidine versus dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided infraclavicular brachial plexus block. Materials and Methods: The present triple-blinded, randomised controlled trial was conducted on 58 American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective forearm surgery between August 2023 and October 2024 at PBMH, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. Group I (n=29) received 20 mL of 0.5% ropivacaine with 8 mg dexamethasone, while Group II (n=29) received 20 mL of 0.5% ropivacaine with dexmedetomidine (1 mu g/kg). The primary outcome was the duration of sensory block. Secondary outcomes included the onset of sensory and motor block, duration of motor block, time to first analgesic request, total analgesic requirements, haemodynamic parameters, and adverse effects. Data were analysed using unpaired t-tests and Mann-Whitney U tests for continuous variables, and Fisher's exact test for categorical variables. Repeated measures Analysis of Variance (ANOVA) was used for haemodynamic parameters (p<0.05 considered significant). Results: The mean age was 38.83 +/- 11.57 years in Group I and 39.97 +/- 13.51 years in Group II, with comparable gender distribution (male/female: 15/14 vs. 12/17), Body Mass Index (BMI) (24.35 +/- 2.86 vs. 24.12 +/- 4.13 kg/m2), and ASA status. Group II (dexmedetomidine) demonstrated a significantly faster onset of sensory block (7.69 +/- 2.09 vs. 9.83 +/- 1.98 minutes, p<0.01) and motor block (11.24 +/- 2.34 vs. 13.21 +/- 1.88 minutes, p<0.01). The duration of sensory block (792.8 +/- 170.8 vs. 610.3 +/- 89.38 minutes; p<0.01) and motor block (667.8 +/- 152.6 vs. 535.9 +/- 88.7 minutes; p<0.01) was significantly prolonged in the dexmedetomidine group. Time to first analgesic requirement was 883.4 +/- 159.5 versus 706.6 +/- 100.5 minutes (p<0.01), with 24-hour tramadol consumption of 135.69 +/- 57.64 versus 189.32 +/- 64.05 mg (p<0.01) in Groups II and I, respectively. Haemodynamic parameters remained stable in both groups, with no significant differences in adverse effects. Conclusion: Dexmedetomidine (1 mu g/kg) as an adjuvant to 0.5% ropivacaine in infraclavicular brachial plexus blocks provides a faster onset, prolonged duration of analgesia, and reduced postoperative analgesic requirements compared to dexamethasone (8 mg), with a comparable safety profile.
Keywords:
Analgesia
Forearm
Pain
Postoperative analgesia
Regional anaesthesia
Ultrasonography
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