Dexmedetomidine and Dexamethasone Added as Adjuvant Infraclavicular Brachial Plexus Block in Upper Limb Surgery

Comparison of the Anesthetic Effects of Dexmedetomidine and Dexamethasone Added as Adjuvant to Ultrasonography-Guided Infraclavicular Brachial Plexus Block in Upper Limb Surgery

The aim of this study was to investigate the effect of dexmedetomidine and dexamethasone added during USG-guided infraclavicular block on block onset time, total block time and time to first analgesic need in patients undergoing upper extremity surgery.

Study Overview

• Status: Recruiting
• Conditions: Acute Pain; Anesthesia; Post Operative Pain
• Intervention / Treatment: Procedure: Infraclavicular Block with Dexmedetomidine and Dexamethasone

Detailed Description

Brachial plexus blocks are successfully applied for perioperative/postoperative analgesia in upper extremity surgical procedures. These blocks include infraclavicular, supraclavicular, interscalene, and axillary blocks. The reason why infraclavicular block is preferred is that it provides comprehensive anesthesia/analgesia of the upper extremity. While the axillary approach may fail to block the musculocutaneous nerve that causes tourniquet pain, the interscalene and supraclavicular approaches generally fail to provide anesthesia in the distribution of the ulnar nerve. Other advantages include the lower risk of lung and pleural puncture compared to interscalene and supraclavicular blocks and the lower probability of injury to neurovascular structures due to the location of the block, unlike the interscalene approach.

Local anesthetics are used to block conduction in nerve fibers during brachial plexus blocks. Studies have shown that the commonly used bupivacaine and ropivacaine 0.25% concentrations are not recommended for anesthesia. Bupivacaine 0.5% and ropivacaine 0.5% have been shown to be similar in terms of sensory and motor block onset time, total sensory and motor block duration, analgesia duration, anesthesia duration, paresis and paralysis incidence. The minimum dose of bupivacaine 0.5% required for complete sensory block was determined as 14mL, but the onset time of the block performed at this low dose was recorded as a late onset of 40 minutes (30-45 minutes). It was observed that the onset time decreased to as short as 15 minutes (min) after the application of 30mL bupivacaine 0.5%. In order to reduce the amount of local anesthetic used, to avoid local anesthetic toxicity, to shorten the block onset time and to extend the postoperative analgesia period, a different local anesthetic or adjuvants were used together with bupivacaine. Bupivacaine used with lidocaine has been observed to have a faster onset of action. Other adjuvants added to accelerate the onset of block and improve the quality of the block include alpha-2 agonists (clonidine and dexmedetomidine), opioids (fentanyl and tramadol), and steroids (dexamethasone). Dexmedetomidine is an adjuvant that is an alpha-2 adrenergic agonist and has been observed to have a synergistic effect with local anesthetics and to prolong their duration of activity. The addition of dexmedetomidine 50 µg and 75 µg has been associated with a decrease in the time to onset of sensory and motor block, a decrease in postoperative morphine consumption, and an increase in the duration of sensory block, motor block, and the time to first morphine request. Dexmedetomidine 75 µg has been associated with an increased incidence of preoperative and intraoperative hypotension episodes. Dexamethasone, a perineural adjuvant, has been shown in many studies to significantly shorten the onset of sensory and motor block and prolong the duration of analgesia. Perineural dexamethasone is more commonly used intravenously for block. Currently, many studies have compared the effects of various perineural dexamethasone doses, such as 1 mg, 2 mg, 4 mg, 5 mg and 8 mg, on block, but the results remain controversial. Studies have shown that there is no difference in safety and efficacy between 4 and 8 mg perineural dexamethasone. Another study reported that 4 mg perineural dexamethasone constitutes a ceiling dose for prolonging the duration of analgesia when used with local anesthetics for block.

• Study Type: Observational
• Enrollment (Estimated): 44

Contacts and Locations

• Study Contact: Name: ZELİHA TUNCEL, ASC PROF; Phone Number: 5053577483; Email: zelihalara@yahoo.com
• Study Contact Backup: Name: ZELİHA TUNCEL, ASC PROF; Phone Number: 9; Email: zelihalara@yahoo.com

Study Locations

• Turkey (Türkiye)
  • Umraniye
    • Istanbul, Umraniye, Turkey (Türkiye), 34034
      • Recruiting
      • Umraniye Education and Research Hospital
      • Contact: Zeliha TUNCEL, asc prof; Phone Number: 905053577483; Email: zelihalara@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

A total of 44 adult patients 18 to 70 years, American Society of Anesthesiologists (ASA) I-II who underwent upper extremity surgery were included in Orthopedics and Traumatology Clinic.

Description

Inclusion Criteria:

• 18-70 years
• ASA I-II

Exclusion Criteria:

• Under 18 years of age and older than 70 years of age,
• presence of brachial plexus injury,
• patients with bleeding diathesis,
• presence of allergy, -contralateral diaphragmatic paralysis, -
• presence of nerve injury secondary to trauma,
• pre-existing neuropathy of the surgical extremity,
• presence of severe pulmonary,
• renal and hepatic disease,
• congestive heart failure (NYHA stage 3-4),
• uncontrolled diabetes mellitus,
• history of neuromuscular disease,
• patients with extreme obesity or malnutrition (BMI > 30 kg-1m2 or BMI <20 kg-1m2),
• presence of epilepsy,
• history of peripheral vascular disease,
• history of chronic pain or fibromyalgia,
• pregnant and lactating patients,
• patients with local infection at the injection site,
• patients undergoing general anesthesia due to inadequacy of the block,
• patients refusing to give informed consent,
• history of recreational substance use, and chronic narcotic-based painkillers

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group Dexmedetomidine: (n:22); A total volume of 30 mL of 0.5% bupivacaine, 14 mL of 2% lidocaine and 50 μgr of dexmedetomidine in 1 mL of normal saline is administered to the patients.	Procedure: Infraclavicular Block with Dexmedetomidine and Dexamethasone; Infraclavicular block with Dexmedetomidine and Dexamethasone was performed at least 30 min before the start of the operation. The patient was positioned in a supine position arms at the sides or in 90 degree abduction, head turned to the other side. Infraclavicular block was performed with the lateral sagittal technique, while the USG probe was placed under the clavicle and medial to the coracoid process, providing a brachial plexus image in the form of a hyperechoic outer ring and hypoechoic circles, like a classic honeycomb image. A local anesthetic mixture was injected with a 100 mm block needle with negative aspiration and its spread in tissue planes was observed. If the VAS score was 3 or above, tramadol 1 mg kg-1 was administered as an analgesic drug.
GroupDexamethasone: (n:22); Patients are administered 0.5% bupivacaine 15 mL, 2% lidocaine 14 mL and 4 mg dexamethasone in 1 ml normal saline with a total volume of 30 mL	Procedure: Infraclavicular Block with Dexmedetomidine and Dexamethasone; Infraclavicular block with Dexmedetomidine and Dexamethasone was performed at least 30 min before the start of the operation. The patient was positioned in a supine position arms at the sides or in 90 degree abduction, head turned to the other side. Infraclavicular block was performed with the lateral sagittal technique, while the USG probe was placed under the clavicle and medial to the coracoid process, providing a brachial plexus image in the form of a hyperechoic outer ring and hypoechoic circles, like a classic honeycomb image. A local anesthetic mixture was injected with a 100 mm block needle with negative aspiration and its spread in tissue planes was observed. If the VAS score was 3 or above, tramadol 1 mg kg-1 was administered as an analgesic drug.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
infraclavicular block onset time	Sensory block / motor block onset time	24 -48 hours
postoperative analgesic drug requirement	opioid total amount micrograms	24 -48 hours
infraclavicular total block time	block time hours	24 -48 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
investigate the effects on VAS score and sedation level in the first 24 hours postoperatively	VAS score	24 -48 hours
advers event Perioperative and postoperative period	Nausea,Vomiting,Hypotension,Bradycardia, Nerve damage	24 -48 hours

Collaborators and Investigators

• Sponsor: Umraniye Education and Research Hospital
• Investigators: Study Director: ZELİHA TUNCEL, ASC PROF, Umraniye ERH

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2026
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): July 30, 2026

Study Registration Dates

• First Submitted: December 22, 2024
• First Submitted That Met QC Criteria: January 12, 2025
• First Posted (Actual): January 16, 2025

Study Record Updates

• Last Update Posted (Actual): February 19, 2026
• Last Update Submitted That Met QC Criteria: February 16, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: dexmetomidine; infraclavicular nerve block; dexamethosone
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Acute Pain; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Azoles; Polycyclic Compounds; Imidazoles; Pregnadienes; Pregnanes; Steroids; Fused-Ring Compounds; Steroids, Fluorinated; Pregnadienetriols; Dexamethasone; Dexmedetomidine
• Other Study ID Numbers: UERH-AR-ZT-11

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No