Background: This study is to compare dexamethasone and dexmedetomidine as adjuvant to levobupivacaine in ultrasound guided (USG) infraclavicular brachial plexus block for distal upper limb surgery.

Methodology: Eighty ASA I−II patients posted for elective forearm and hand surgery under infraclavicular brachial plexus block were  allocated  into 2 equal groups in a random, double blinded fashion. Each group received 30 ml of 0.5% levobupivacaine either with 2 ml of dexamethasone(8mg) (D group, n = 40) or  2 ml of dexmedetomidine ( 50 microg diluted with normal saline) (DEX group, n = 40). USG  guided infraclavicular brachial plexus block was given to all the patients. After performing the block vital parameters were recorded every 5 min until 30 min. The onset time and duration of sensory block,  motor block  and duration of analgesia were assessed.

Results: Demographic data and surgical characteristics were similar in both groups. The onset time of sensory block  was similar in both groups. The onset time of motor block was earlier in DEX group .  The durations of sensory and motor blockade  were longer in group D than in group DEX (p<0.001). Mean arterial blood pressure levels at 5, 10, 15, 20, 25 and 30 minutes were statistically insignificant between the two groups (p>0.05). The mean pulse rate at different time intervals were also statistically insignificant between the groups (p>0.05).There were two   failed blocks and excluded from the study and neither of the patients had any side effects.

Conclusion: Both dexmedetomidine and dexamethasone are good adjuvants to levobupivacaine in peripheral nerve blocks. The present study suggests that dexamethasone is a better choice as it prolongs the duration of  sensory and motor blockade as well as duration of analgesia of infraclavicular brachial plexus block without any adverse side effects .