Dexmedetomidine Versus Nalbuphine as Adjuvants to 0.5% Ropivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Cureus 17(6): e86913, June 2025. | doi:10.7759/cureus.86913

This prospective, double-blind randomized controlled trial compared dexmedetomidine and nalbuphine as adjuvants to 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries. Sixty patients were randomized into two groups. Group D received dexmedetomidine, and Group N received nalbuphine.

Dexmedetomidine resulted in a faster onset and significantly prolonged duration of sensory and motor blocks. Patients in Group D also required fewer rescue analgesic doses and had a longer time to first analgesic request. However, dexmedetomidine was associated with higher incidences of bradycardia and hypotension, whereas nalbuphine provided better hemodynamic stability but with a higher incidence of nausea and pruritus. Sedation scores were significantly higher in the dexmedetomidine group in the immediate postoperative period.

The study concluded that dexmedetomidine provides superior block characteristics and analgesia but at the expense of hemodynamic side effects. Nalbuphine, though offering shorter duration of analgesia, maintained stable hemodynamics and may be preferable in patients where cardiovascular stability is a concern. The choice between these adjuvants should be individualized based on patient comorbidities and procedural goals.