Abstract:

The study aimed to investigate the analgesic effect and adverse reactions of ropivacaine alone and its combination with adjuvants dexamethasone or dexmedetomidine in patients undergoing selective ultrasound-guided supraclavicular brachial plexus nerve block (SBPB) for proximal upper limb fractures. A total of 120 patients who underwent internal fixation surgery for proximal upper limb fractures under general anesthesia were randomly divided into three groups: ropivacaine (R), dexmedetomidine (DexM), and dexamethasone (DexA), with 40 patients in each group. After surgery, all patients underwent ultrasound-guided SBPB on the affected side using different interventions: the R group received 20 mL of 0.33% ropivacaine, the DexM group received 20 mL of 0.33% ropivacaine combined with 1 μg/kg of DexM, and the DexA group received 20 mL of 0.33% ropivacaine combined with 10 mg of DexA. Patient-controlled intravenous analgesia (PCIA) was used for postoperative pain management. The study recorded various outcomes, including pain scores using the Numeric Rating Scale (NRS) at different time points, duration of sensory block, first press time of PCIA, morphine consumption, Athens Insomnia Scale (AIS) scores, the occurrence of adverse reactions, and changes in inflammatory indicators. The results demonstrated that compared to the R group, both the DexM and DexA groups had lower postoperative NRS scores at different time points, longer duration of sensory block, delayed first press of the analgesic pump, lower morphine dosage at 48 h, and lower AIS scores, all of which were statistically significant. Compared to the DexA group, the DexM group had lower NRS scores at various time points, a shorter time to first press the analgesic pump, and lower morphine dosage. However, there was no significant difference in sensory block duration and AIS scores between the DexM and DexA groups. The combination of DexA or DexM with ropivacaine for SBPB was found to prolong the analgesic effect, inhibit inflammatory reactions, and show no significant adverse reactions. In this study, DexA exhibited superior analgesic and prolonging effects compared to DexM.

Key words: Upper clavicular brachial plexus block, Ropivacaine, Adjuvant, Fracture