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

## TL;DR

This study found that combining dexamethasone and dexmedetomidine with bupivacaine in a costoclavicular block improves the duration and speed of pain relief for upper limb surgeries.

## Contribution

The study introduces a novel combination of dexamethasone and dexmedetomidine as adjuvants to bupivacaine in costoclavicular blocks.

## Key findings

- The combination group had significantly longer analgesic duration compared to the individual adjuvant groups.
- The combination also prolonged sensory and motor block durations and reduced onset time.
- No significant sedation or adverse effects were observed in the combination group.

## Abstract

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