Comparative evaluation of 0.75% Ropivacaine with dexmedetomidine versus 0.75% Ropivacaine with dexamethasone in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries

Abstract Background: Supraclavicular brachial plexus block provides excellent anesthesia and analgesia for upper limb surgeries. Addition of adjuvants, like dexmedetomidine/dexamethasone, prolongs block duration and improves patient comfort. However, there is a scarcity of direct comparative evidence on their relative efficacy when combined with ropivacaine in ultrasound (USG)-guided supraclavicular blocks. Objective: The objective of the study was to compare 0.75% ropivacaine with dexmedetomidine versus 0.75% ropivacaine with dexamethasone in USG-guided supraclavicular brachial plexus block for upper limb surgeries. Materials and Methods: In this prospective study, adult patients undergoing elective upper limb surgery under supraclavicular brachial plexus block were allocated into two groups. Group A received 20 mL 0.75% ropivacaine plus dexmedetomidine (0.5 μg/kg), whereas Group B received 20 mL 0.75% ropivacaine plus dexamethasone (8 mg). Block onset times and block durations for both sensory and motor components were recorded. Hemodynamic parameters and adverse events were also documented. Results: Groups were comparable for age (44.75 ± 11.52 vs. 43.30 ± 13.67 years, P = 0.6473) and American Society of Anesthesiologists Grade (1.55 ± 0.50 vs. 1.45 ± 0.50, P = 0.4801). Mean motor block duration was significantly prolonged in Group A compared to Group B (9.85 ± 0.96 h vs. 5.95 ± 0.78 h, P = 0.0001). Sensory block duration was likewise longer in Group A (12.00 ± 0.58 h vs. 7.80 ± 0.52 h, P = 0.0001). Motor and sensory onset times were also significantly different between the two groups, with Group B exhibiting faster onset. No major adverse events were noted in either group. Conclusion: Dexmedetomidine as an adjuvant to 0.75% ropivacaine in USG-guided supraclavicular block provides significantly longer motor and sensory block duration compared to dexamethasone, albeit with a slightly delayed onset profile.