Effects of a triple adjuvant combination of buprenorphine, clonidine, and dexamethasone on duration of brachial plexus blocks for upper extremity surgery: A prospective, randomized clinical trial

Background Interscalene brachial plexus blocks (ISB) are commonly used as a perioperative pain strategy for shoulder arthroscopy. Though bupivacaine is the current standard of care for analgesia, adjuvant therapies including buprenorphine, clonidine, and dexamethasone (BCD) have each demonstrated analgesic benefits. This randomized controlled trial evaluated whether combining these three adjuvants with bupivacaine prolongs analgesia and reduces opioid consumption compared with bupivacaine alone for single-shot ISB. Methods This single-blinded, randomized controlled trial, 127 adult patients undergoing shoulder arthroscopy at a single academic center who received either Plain-BPV ( n = 66) or BPV-BCD ( n = 61). Visual analog scale (VAS) pain scores and opioid consumption, measured in morphine milligram equivalents (MME), were assessed at 2-, 24-, and 48-h postoperatively. Results Demographics and operative characteristics were similar between groups. At 24 h, BPV-BCD significantly reduced pain scores compared with Plain-BPV (3.2 vs. 5.0 VAS; p < 0.001). Opioid consumption was also lower with BPV-BCD (4.4 vs. 7.8 MME; p = 0.001). Conclusions Combining BCD with bupivacaine for single-shot ISB significantly lowered 24-h pain scores and opioid requirements. These findings highlight the potential efficacy of this combination to optimize pain management following shoulder arthroscopy.