Comparative study between the effect of dexmedetomidine versus dexamethasone as adjuvant to levobupivacaine in interscalene block using ultrasound in shoulder arthroscopy

Background and aim Steroids have good analgesic properties and anti-inflammatory actions. Postoperative analgesia is influenced by the perineural injection of steroids. This study aimed to assess the effects of dexamethasone and dexmedetomidine at low and high doses on hemodynamics, sensory and motor block, analgesic intake, stress response, postoperative pain, and postoperative complications. Patients and methods One hundred twenty patients who underwent shoulder surgery were recruited in the study. Every patient had perioperative levobupivacaine and then, according to their group, received either normal saline, dexamethasone, or dexmedetomidine at low and high doses. The patients were subjected to the following measurements: heart rate (HR) and mean arterial blood pressure (MAP) before the block at baseline and then at 15, 30, 60, 90, and 120 min intraoperative, the onset time and the duration of sensory and motor blockade, and onset of analgesia postoperatively, visual analog scale score at 4, 8, 12, 16, 20, and 24 h postoperative, total amount of paracetamol taken, blood cortisol level, and postoperative complications. Results The addition of dexamethasone and dexmedetomidine for interscalene block reduced the onset time of the sensory and motor block by statistically significant values. Significant reduction in intraoperative HR and MAP and extension of the duration of sensory and motor blocks in dexmedetomidine at low and high doses and dexamethasone groups when compared to the control group. Also, the quality of postoperative analgesia was better with decreased levels of visual analog scale and decreased analgesic consumption in dexamethasone and dexmedetomidine groups compared to the control group. Also, stress response showed a significant decrease in all groups compared to the control group. Conclusion Dexmedetomidine 100 μg is as effective as dexamethasone 8 mg and better than dexamethasone 4 mg as adjuvants with local anesthetic in interscalene brachial plexus block during shoulder arthroscopy with a significant reduction in intraoperative HR and MAP in dexmedetomidine group than dexamethasone group.