Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Erector Spinae Plane Block for Acute Pain Management in Patients With Traumatic Rib Fractures

Inclusion Criteria:

• Adult patients aged 18 to 65 years
• Both sexes
• American Society of Anesthesiologists (ASA) physical status I-II
• Acute traumatic rib fractures confirmed by appropriate imaging
• Flail-chest patients who are hemodynamically and respiratory stable to undergo erector spinae plane block (ESPB) and reliable assessment
• Spontaneously breathing patients or patients receiving supplemental oxygen/non-invasive respiratory support without an immediate indication for intubation
• Ability to report pain using a Numeric Rating Scale (NRS)
• Presentation within 24 hours of trauma
• Ability to provide written informed consent

Exclusion Criteria:

• Patient refusal to participate
• Immediate need for endotracheal intubation or invasive mechanical ventilation prior to randomization or block placement
• Hemodynamic instability requiring immediate resuscitation or vasopressor support precluding safe regional anesthesia
• Cardiorespiratory arrest or peri-arrest status
• Severe associated traumatic brain injury or other injuries preventing reliable clinical evaluation
• Major associated injury requiring immediate emergency operative or interventional procedures that prevent protocol completion
• Coagulopathy or any contraindication to regional anesthesia
• Local infection at the anticipated block needle insertion site
• Known allergy to amide local anesthetics, dexmedetomidine, or dexamethasone
• Significant bradyarrhythmia, high-grade atrioventricular block, or contraindication to dexmedetomidine
• Chronic opioid consumption or chronic pain syndromes requiring regular analgesic therapy
• Prior regional anesthesia performed for the current trauma
• Inability to cooperate with the procedure or pain evaluation