EP024 Comparison of efficacy of dexamethasone vs dexmedetomidine as adjuvants with ropivacine in scalp nerve block for patients undergoing awake craniotomy: a randomised controlled trial

<h3>Background and Aims</h3> Awake craniotomy is a specialized neurosurgical procedure that demands optimized anesthetic techniques to ensure patient comfort and facilitate intraoperative neurological monitoring. Scalp nerve block using local anesthetics combined with adjuvants has emerged as a key strategy. Literature regarding the dexamethasone vs dexmedetomidine as adjuvants in scalp block is less limited.The primary objective was to assess the time to the first rescue analgesic dose, with secondary objectives including onset of sensory block, hemodynamic stability, postoperative pain, and overall analgesic consumption. <h3>Methods</h3> This prospective, double-blinded, randomized controlled trial was conducted over 12 months in a tertiary care center. Fifty adult patients (aged 18– 65 years) undergoing elective awake craniotomy were randomized into two groups: Group RMED received a scalp nerve block with 0.5% Ropivacaine combined with Dexmedetomidine (1 µg/kg), and Group RMETH received 0.5% Ropivacaine combined with Dexamethasone (8 mg). Outcomes included the time to first rescue analgesia (primary outcome), onset of sensory block (pinprick test), intraoperative hemodynamic stability (HR and MAP), postoperative pain scores (NRS at intervals up to 24 hours), total 24-hour analgesic consumption, and the incidence of adverse events, including bradycardia, hypotension, and respiratory depression. <h3>Results</h3> Both groups achieved effective sensory blockade with minimal complications. Group RMED demonstrated a significantly prolonged duration of analgesia compared to Group RMETH (median: 16 hours vs. 12 hours; p&lt;0.05). The onset of sensory blockade was similar between groups (median: 6.5 minutes for RMED vs. 7 min for RMETH; p&gt;0.05). Postoperative pain scores (NRS score) were significantly lower in Group RMED, and total 24-hour rescue analgesic consumption was significantly reduced in RMED (p&lt;0.05). <h3>Conclusions</h3> Dexmedetomidine, as an adjuvant to 0.5% ropivacaine in scalp nerve blocks, provided a superior analgesic profile compared to dexamethasone in term of duration of pain relief, enhanced postoperative comfort, reduced analgesic requirement and ensured stable perioperative hemodynamics.