Comparison between dexamethasone and dexmedetomidine combined with bupivacaine on pain relief after shoulder arthroscopy: A randomized clinical trial

ABSTRACT Background: Postoperative pain management following shoulder arthroscopy remains a significant clinical challenge. Shoulder block modality, which combines axillary nerve block (ANB) with suprascapular nerve block (SSNB), provides analgesia with few reported hazards. Dexamethasone and dexmedetomidine are used as adjuvants to prolong analgesia, but their comparative efficacy remains unclear. This study evaluates their effectiveness with bupivacaine in SSNB and ANB for postoperative pain control. Patients and Methods: This is a prospective, double-blind, randomized clinical study carried out at Assiut University Hospital. The study included 60 patients, between 20 to 65 years old, who were scheduled for elective shoulder arthroscopies under general anesthesia (ASA) class I or II. As an adjuvant to shoulder block in patients undergoing shoulder operations, patients were randomly divided into two equal groups: Dexamethasone group and Dexmedetomidine group. The Dexamethasone group received bupivacaine 0.5% (20 mL) with dexamethasone (4 mg in 1 mL), while the Dexmedetomidine group received bupivacaine 0.5% (20 mL) plus dexmedetomidine (1 mcg/kg in 1 mL). A 24-hour postoperative numerical rating pain scale (NRS) rating and opioid consumption were recorded for both groups. Results: At several time intervals up to 24 hours postoperatively, patients in the dexmedetomidine group showed lower NRS ratings than those in the dexamethasone group ( P < 0.05). The dexmedetomidine group’s time to first analgesic request was substantially longer (19.86 ± 1.36 hours) than the dexamethasone group’s (16.57 ± 1.17 hours) ( P < 0.001). Additionally, the dexmedetomidine group consumed fewer opioids overall. Conclusion: Dexmedetomidine as an adjuvant in shoulder block provides more postoperative analgesia and lower opioid consumption.