Comparison of dexamethasone and dexmedetomidine as adjuvants to 0.5% bupivacaine in ultrasound-guided infraclavicular brachial plexus block for elective upper limb surgeries: a randomized double-blind comparative study.

Dr. Kammali  Akhil; Dr.Sirisha  Mutchi; Dr Vaddi  Preethi

doi:10.51168/sjhrafrica.v7i2.2763

Authors

Dr. Kammali Akhil Consultant Anaesthesiologist, DVC Hospital & Research Center, Vadlamudi, Guntur, Andhra Pradesh, India
Dr.Sirisha Mutchi Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
Dr. Vaddi Preethi Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2763

Keywords:

Brachial plexus block, bupivacaine, dexamethasone, dexmedetomidine, infraclavicular block, postoperative analgesia, ultrasound-guided regional anesthesia

Abstract

Background

Ultrasound-guided infraclavicular brachial plexus block is an effective regional anesthetic technique for upper limb surgery. The addition of adjuvants to long-acting local anesthetics improves block quality and extends postoperative analgesia. Dexamethasone and dexmedetomidine are frequently used, but their comparative clinical profile remains relevant for routine practice.

Objectives

To compare dexamethasone and dexmedetomidine as adjuvants to 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block in elective upper limb surgeries.

Methods: This prospective, randomized, double-blind, parallel-group comparative study was conducted from 1 May 2024 to 30 April 2025 and included 60 adult patients aged 18-60 years with ASA physical status I-II. A computer-generated variable-block sequence with sequentially numbered, opaque, sealed envelopes allocated participants in a 1:1 ratio. Group Dex received 25 mL of 0.5% bupivacaine with 75 mcg dexmedetomidine, while Group D received 25 mL of 0.5% bupivacaine with 6 mg dexamethasone. Sensory and motor onset, block duration, postoperative analgesia, pain scores, hemodynamics, and adverse events were assessed.

Results

Both groups were comparable for age, sex, body mass index, ASA grade, and baseline hemodynamic profile. Group Dex had faster sensory onset (4.27 +/- 1.07 versus 4.82 +/- 0.93 minutes) and motor onset (6.18 +/- 0.95 versus 6.74 +/- 1.05 minutes). Sensory block duration was longer in Group Dex (774.75 +/- 58.01 versus 545.34 +/- 66.43 minutes), as was motor block duration (505.34 +/- 66.43 versus 451.17 +/- 47.02 minutes). Postoperative analgesia was also longer in Group Dex (14.71 +/- 1.85 versus 13.54 +/- 0.75 hours). Early postoperative VAS scores were lower in Group Dex, with similar 24-hour scores.

Conclusion

Dexmedetomidine provided faster onset, longer sensory and motor blockade, longer postoperative analgesia, and better early pain control compared with dexamethasone.

Recommendations

Dexmedetomidine can be considered when prolonged analgesia is preferred, with careful monitoring for bradycardia and sedation.

Author Biographies

Dr. Kammali Akhil, Consultant Anaesthesiologist, DVC Hospital & Research Center, Vadlamudi, Guntur, Andhra Pradesh, India

is a Consultant Anaesthesiologist at DVC Hospital & Research Center, Vadlamudi, Guntur, Andhra Pradesh, India. He is involved in perioperative patient care, regional anaesthesia, airway management, and anaesthetic support for surgical procedures. His areas of clinical interest include safe anaesthetic practice, perioperative monitoring, and pain management.
Dr.Sirisha Mutchi, Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

is an Assistant Professor in the Department of Anaesthesiology at Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. She is involved in undergraduate and postgraduate teaching, clinical anaesthesia services, perioperative care, and academic activities. Her areas of interest include regional anaesthesia, perioperative medicine, postoperative analgesia, airway management, and patient safety in anaesthesia practice.
Dr. Vaddi Preethi, Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

completed her MBBS from GSL Medical College, Rajahmundry, Andhra Pradesh, and obtained her MD in Anaesthesia from Great Eastern Medical School and Hospital, Srikakulam. She subsequently worked as a Senior Resident in the Department of Anaesthesia at Great Eastern Medical School and Hospital, Srikakulam, where she gained clinical and academic experience in perioperative anaesthesia care, airway management, regional anaesthesia, and critical care support. She is currently working as an Assistant Professor in the Department of Anaesthesia at Andhra Medical College, Visakhapatnam. Her areas of academic interest include clinical anaesthesia, perioperative medicine, regional anaesthesia, and patient safety. ORCID iD: https://orcid.org/0009-0008-5694-8817

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