Dexamethasone, Dexmedetomidine, and Combination of Dexamethasone-Dexmedetomidine as Adjuvants to Bupivacaine for Costoclavicular Block: A Randomized Controlled Study.

Background

The costoclavicular block is an upcoming approach in blocking the brachial plexus for upper limb surgeries. The addition of dexamethasone and dexmedetomidine to the local anesthetic mixture can prolong the duration of analgesia of brachial plexus block. We compared the addition of three different adjuvants-dexamethasone, dexmedetomidine, and dexamethasone-dexmedetomidine combination with bupivacaine in costoclavicular block.

Methods

We randomized 105 patients undergoing elective hand and forearm surgery under ultrasound guided costoclavicular block. Along with the local anesthetics, Group D patients received 4 mg dexamethasone, Group X patients received 1 µg/kg dexmedetomidine, and Group D-X patients received 4 mg dexamethasone and 1 µg/kg dexmedetomidine. The primary outcome analyzed was the analgesic duration. The secondary outcomes studied were the duration of sensory and motor block, time to onset of sensory and motor block, sedation scores, and adverse effects.

Results

The duration of analgesia was significantly prolonged in Group D-X when compared to that in Group X and Group D [(19 h; IQR, 18.5-19.0 h) versus (16 h; IQR, 15.5-16.5 h) versus (13 h, IQR, 12-14 h) p value < 0.001]. The duration of sensory block was significantly prolonged in Group D-X compared to that in Group X and Group D [(15 h, IQR, 15-16 h) versus (13 h, IQR, 12-14 h) versus (10 h, IQR, 10-11 h) p value < 0.001]. Similarly, the duration of motor block was prolonged in Group D-X compared to that in Group X and Group D [(16 h; IQR: 16-17.5 h) versus (14 h; IQR; 13-15 h) versus (11 h; IQR: 11-12 h) with significant p value < 0.001. Also, the time to onset of sensory and motor block was earlier in Group D-X. The sedation scores were not significant, and no adverse events were observed.

Conclusion

Addition of dexamethasone and dexmedetomidine together to a local anesthetic in ultrasound guided costoclavicular block resulted in faster onset with longer analgesic and sensorimotor block duration. Trial Registration: Clinical Trials Registry-India: CTRI/2024/01/061072.