Ulnar artery Doppler indices, a novel emerging predictor of segmental ulnar sparing after supraclavicular block: A prospective observational study.

Context: Ultrasound-guided supraclavicular and infraclavicular brachial plexus block (BPB) are the most effective approaches for providing anesthesia and analgesia for upper limb surgeries. Aims: In our study, we aimed to compare sensory and motor onset and offset time and other parameters related to ultrasound-guided supraclavicular and infraclavicular BPB for upper limb orthopedic surgeries with the use of a peripheral nerve stimulator. Settings and Design: This is a prospective, randomized, controlled study. Materials and Methods: Group S ( n = 29) received ultrasound-guided supraclavicular BPB, and Group I ( n = 29) received ultrasound-guided infraclavicular BPB. The primary objective was to compare these two blocks for sensory block onset time. Statistical Analysis: For data analysis, two-tailed Student t test and chi-square test were applied. Results: Mean values of the onset of sensory block in Group I were 4.24 ± 3.3 min, which was earlier than that of Group S, which was 5.24 ± 2.25 min. The P value was 0.18. The mean onset of the motor block was also earlier in the infraclavicular block, that is, 7.66 ± 4.89 min, than in supraclavicular block, in which it was 8.76 ± 3.61 min. The P value was 0.33. Duration of motor block in the infraclavicular block was longer, that is, 833.41 ± 510.6 min than the supraclavicular block, which was 523.72 ± 237.82 min. The P value was 0.0045. Duration of sensory block in infraclavicular block was 857.62 ± 478.93 min, which was longer than that of supraclavicular block, in which it was 511.07 ± 317.43 min. The P value was 0.00197. Conclusion: It is concluded that when both ultrasound and nerve stimulator are used, infraclavicular block is safer and advantageous than supraclavicular BPB. Onset of sensory block is faster in infraclavicular block than supraclavicular block.

Objective: Supraclavicular brachial plexus block is a highly popular upper extremity anesthetic technique. Theoretically, after local anesthetic agent is injected, temporary vasodilatation, sensory loss and motor weakness ensue. The assessment of successful block relies on subjective data of sensory block and patient co-operation. The present study hypothesized that perfusion index (PI) is an early predictor and provide a cut-off value for the successful block. Materials and Methods: Sixty-two patients undergoing upper extremity operation under ultrasound-guided supraclavicular brachial plexus block were included. PI values were assessed on the operated limb at baseline, 0, 1, 3, 5, and 10 minutes after block. The patients were divided into three groups. Upon incision, patients that reported pain but tolerated the operation after anesthetic supplement were in the supplement group, patients that reported persistent pain after anesthetic supplement were in the failed group, and patients that did not required any supplement were in the complete group. The three groups were monitored with PI values. Results: The supraclavicular brachial plexus block of fifty-nine patients (95.16%) were successfully blocked, which 42 patients (67.74%) had complete block and 17 patients (27.42%) needed supplemental treatment. Three patients (4.84%) had failed block and were converted to general anesthesia. The PI value was continuously rising from baseline in successfully blocked patients. PI value at three minutes after local anesthetic injection showed block success at cut-off value of 3.6, respectively. Conclusion: Successful block could be determined early by the increase of PI value from baseline. A PI value of more than 3.6 at 3-minute after block is a good early predictor of successful block. Keywords: Perfusion index; Ultrasound-guided regional anesthesia; Brachial plexus block; Supraclavicular block; Regional anesthesia; Peripheral anesthesia

Editor, Plasma levels of local anaesthetic following peripheral nerve blockade are not well studied and as discussed by Rosenberg et al.1 a decade ago, there is no scientific basis for a universal maximum mg or mg kg−1 dose. Since the advent of widespread use of ultrasound for peripheral nerve blockade, our institution now uses supraclavicular brachial plexus block as the primary brachial plexus block for hand and arm surgery. The brachial plexus at the supraclavicular level is almost always accessible regardless of body habitus and there is relatively rapid onset of the block. Despite these advantages, it does require a large dose of local anaesthetic to achieve surgical anaesthesia. Previous studies suggest up to 32 ml for a 90% success rate2. Not infrequently, this puts the dose into what would normally be considered the toxic range if considered in a mg kg−1 dose. To assess our safety margin with regards to systemic toxicity, we assessed the plasma levels of local anaesthetic in 21 patients who presented for hand surgery under supraclavicular block. After ethical approval for this study, which was provided by the Health Research Ethics Board of the University of Alberta, Edmonton, Alberta, Canada (Dr Shane Kimber) on 16 November 2010, reference number Pro00017658 and written consent from the patients, blood samples were obtained at 10, 15, 20 and 25 min to assess for lignocaine and bupivacaine levels. Blood samples were centrifuged, after which the plasma component was removed and frozen at −70°C until analysis. Plasma lidocaine and bupivacaine concentrations using 100 ul of human plasma were measured by HPLC. All blocks were carried out by an anaesthetist experienced with ultrasound-guided supraclavicular blocks. As the block was intended for surgical anaesthesia, our institution's ‘surgical mix’ was used. This consists of 15 ml of 2% lignocaine and 5 ml of 0.5% bupivacaine drawn up into a 30 ml syringe. The absolute volume used was at the discretion of the anaesthetist, but most commonly 30 ml (or one and half syringes of this mixture) was used. Any local anaesthetic used in the skin was also included when total dose was calculated for each patient. The patient demographics and local anaesthetic doses are shown in Table 1, and the plasma concentrations are shown in Table 2. The bupivacaine concentrations in all patients were below the measureable threshold at all time points.Table 1: Patient age and weight and local anaesthetic doseTable 2: Mean (± SD) lignocaine plasma levels and range at each time pointFour of the patients had minor symptoms of local anaesthetic toxicity (nystagmus, circumoral tingling and tinnitus). There were no episodes of serious local anaesthetic toxicity. Interestingly, the patients with mild symptoms of local anaesthetic toxicity did not have the highest plasma lignocaine levels. The patient with the highest levels did not have any signs of local anaesthetic toxicity. Using the Kendall correlation coefficient, we were unable to show any relationship between either the total dose, or the mg kg−1 dose, and the plasma concentration. Using a log normal distribution to model the data (Fig. 1), the probability of the lignocaine level being above 6 μg ml−1 following administration of the block was 25%. The chance of a patient having a plasma lignocaine level of above 12 μg ml−1 was 6%.Fig. 1: Histogram of plasma levels with a log normal distribution curve.In this preliminary study, we have shown that high plasma levels of local anaesthetic can occur after a supraclavicular brachial plexus block. This suggests that the primary reason for a reduction of local anaesthetic toxicity that is seen with the use of ultrasound by Barrington et al.3 is related to the avoidance of intravascular injection. Although there is a reduction in the local anaesthetic volume required for a successful block when using ultrasound, this study suggests that it not reduced sufficiently to ensure that high plasma levels of local anaesthetic are reliably avoided. However, the high plasma concentrations of local anaesthetic that occur following supraclavicular block seem to be well tolerated in a young healthy population. Symptoms of mild local anaesthetic toxicity are common, and in our experience of over 1500 supraclavicular blocks in the past decade there has not been an episode of serious local anaesthetic toxicity associated with this block. The relationship between plasma levels, toxicity and dose of local anaesthetic is unclear, and it is likely that patient factors play a significant role in the likelihood of local anaesthetic systemic toxicity. Further research is required in this area. Acknowledgements relating to this article Assistance with the study: none. Financial support and sponsorship: BCT is supported in part by a Clinical Scholar award from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, Canada and a CAS–Abbott Laboratories Ltd Career Scientist Award in Anesthesia from the Canadian Anesthesiologists’ Society. Conflicts of interest: none.

Background: Brachial plexus block utilizing ultrasound imaging has now become either adjuvant to general anesthesia (GA) or as a mainstay anesthesia modality. There are fewer studies comparing the effects of ropivacaine and levobupivacaine for supraclavicular brachial plexus block. This prospective randomized study compared 0.5% Levobupivacaine and 0.5% Ropivacaine in patients undergoing forearm orthopedic surgeries under Ultrasound Guided Supraclavicular Brachial Plexus Block. Methodology: A total of 56 patients were enrolled and randomized into two groups of 28 patient each. Group R was given 30ml of 0.5% Ropivacaine and Group L was given 30 ml of 0.5% Levobupivacaine in supraclavicular block under ultrasound guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia, and any adverse events. After administration of block, the block characteristics were assessed every 5 min till onset of complete blockade, then hourly till the effect of block. Data between the groups were analyzed using with SPSS 25.0 software. Results: The study shows that there was statistically significant difference in onset of sensory and motor block between Levobupivacaine and Ropivacaine (7.54 min 2.10 vs 8.55 min 2.08) and (12.95 min 2.30 vs 14.07 min 2.22) respectively. The duration of analgesia was more in Levobupivacaine group (9.98 hours 4.88) as compared to Ropivacaine (8.03 hours 3.58). Conclusion: The onset of action of sensory and motor was early with Levobupivacaine and can be a better choice when postoperative analgesia is prime concern. However, where faster recovery of motor function is required Ropivacaine is preferred choice. Key words: Brachial plexus block, ropivacaine, levobupivacaine, supraclavicular brachial plexus block, ultrasound guidance Citation: Shahid R, Prasad MK, Alam MA, Jain P, Reddy MN, Jheetay GS. A prospective randomized study to compare levobupivacaine and ropivacaine in ultrasound-guided supraclavicular brachial plexus block for forearm orthopedic surgery. Anaesth. pain intensive care 2021;25(5): 613–619; DOI: 10.35975/apic.v25i5.1629

Peripheral nerve blocks (PNB) are getting significant recognition for intraoperative and publish operative pain control because of their distinct advantage over general anaesthesia anesthesia. There are different ways to a brachial plexus block. The coracoid infraclavicular approach is feasible in almost all patients. A prospective randomized control trial was performed to compare the clinical effect of infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. Sixty patients receiving upper limb orthopedic surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The supraclavicular brachial plexus block was performed using nerve locater and ultrasound technique with 40 ml of 0.5% bupivacaine 1.5 mg/kg, ligocaine 2% with adrenaline 4mg/kg and distilled water. This study observed which nerve types were stimulated, and scored the sensory and motor blockage. The quality of the block was assessed intra-operatively and postoperatively with modified Lovette rating scale and McGill’s pain score. The duration of the sensory, motor block and the complications were assessed. The patient’s satisfaction with the anesthetic technique was assessed after surgery. In our study we observed similar effect in both infraclavicular and supraclavicular brachial plexus block. The infraclavicular approach may be preferred to the supraclavicular approach as complications are fewer with infraclavicular approach but expertise is needed in infraclavicular block.

Background and Aims:Various opioid additives have been trialed to prolong brachial plexus block. We evaluated the effect of adding nalbuphine hydrochloride to levobupivacaine for supraclavicular brachial plexus blockade. The primary end-points were the onset and duration of sensory and motor blocks and duration of analgesia.Materials and Methods:Seventy-eight patients (aged 25–45 years) posted for ambulatory forearm and hand surgery under supraclavicular brachial plexus block were divided into two equal groups (Groups LN and LC) in a randomized, double-blind fashion. In Group LN (n = 39), 30 ml 0.5% levobupivacaine + 10 mg (diluted in 2 ml 0.9% saline) nalbuphine hydrochloride, and in Group LC (n = 39), 30 ml 0.5% levobupivacaine + 2 ml normal saline (0.9%) were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics, and side effects were recorded for each patient.Results:Although with similar demographic profile and block (sensory and motor) onset time, sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in Group LN (P < 0.05) than Group LC. Postoperative VAS value at 24 h was significantly lower in Group LN (P < 0.05). Intraoperative hemodynamics was comparable between two groups, and no any appreciable side effect was noted throughout the study period.Conclusion:It can be concluded that adding nalbuphine hydrochloride to supraclavicular brachial plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects.

Supraclavicular brachial plexus block is extensively used for primary regional anaesthesia as well as postoperative analgesia for the surgical procedures of the upper limb. The evidence for the use of ultrasound in supraclavicular brachial plexus is growing day by day as it has the advantage of allowing real time visualisation of the plexus, pleura and vessels along with the needle and local anaesthetics spread. Despite this, complications can even arise with ultrasound guided supraclavicular brachial plexus block. Hoarseness of voice due to recurrent laryngeal nerve block is a rare complication of supraclavicular brachial plexus block. There are few reported cases of hoarseness of voice following the right supraclavicular block. There is only one reported case of hoarseness of voice following the left supraclavicular block. Here, we report a case of a 16-year-old boy who developed hoarseness of voice due to left recurrent laryngeal nerve following ultrasound guided left supraclavicular brachial plexus block.

Femoral artery Doppler as a novel predictor of spinal hypotension in elective cesarean delivery cases: a prospective observational study.

Background and Aims:Different additives have been used to prolong brachial plexus block. We evaluated the effect of adding dexmedetomidine to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia.Materials and Methods:A total of 84 patients (20-50 years) posted for elective forearm and hand surgery under supraclavicular brachial plexus block were divided into two equal groups (Group R and RD) in a randomized, double-blind fashion. In group RD (n = 42) 30 ml 0.5% ropivacaine +1 ml (100 μg) of dexmedetomidine and group R (n = 42) 30 ml 0.5% ropivacaine +1 ml normal saline were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics and side-effects were recorded for each patient.Results:Though with similar demographic profile in both groups, sensory and motor block in group RD (P < 0.05) was earlier than group R. Sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RD (P < 0.05) than group R. Post-operative VAS value at 12 h were significantly lower in group RD (P < 0.05). Intra-operative hemodynamics were significantly lower in group RD (P < 0.05) without any appreciable side-effects.Conclusion:It can be concluded that adding dexmedetomidine to supraclavicular brachial plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side-effects.

Objective:Different additives have been used to prolong brachial plexus block. We evaluated the effect of adding magnesium sulfate to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia.Methods:One hundred patients (25–55 years) posted for elective forearm and hand surgeries under supraclavicular brachial plexus block were divided into two equal groups (Groups RM and RN) in a randomized, double-blind fashion. In group RM (n = 50), 30 ml 0.5% ropivacaine plus 150 mg (in 1 ml 0.9% saline) magnesium sulfate and in group RN (n = 50), 30 ml 0.5% ropivacaine plus 1 ml normal saline were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamic variables, and side effects were recorded for each patient.Findings:Though with similar demographic profile and block (sensory and motor) onset time, the sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RM (P = 0.026) than group RN. Postoperative VAS values at 24 h were significantly lower in group RM (P = 0.045). Intraoperative hemodynamics was comparable among two groups and no appreciable side effect was noted throughout the study period.Conclusion:It can be concluded from this study that adding magnesium sulfate to supraclavicular brachial plexus block may increase the sensory and motor block duration and time to first analgesic use, and decrease total analgesic needs, with no side effects.

Supraclavicular brachial plexus blocks are not common in children because of risk of pneumothorax. However, infraclavicular brachial plexus blocks have been described in paediatric patients both with nerve stimulation and ultrasound (US)-guidance. US-guidance reduces the risk of complications in supraclavicular brachial plexus blocks in adults. To compare the success rate, complications and time of performance of US-guided supraclavicular vs infraclavicular brachial plexus blocks in children. Eighty children, 5-15 years old, scheduled for upper limb surgery were divided into two randomized groups: group S (supraclavicular), n = 40, and group I (infraclavicular), n = 40. All blocks performed were exclusively US-guided, by a senior anaesthesiologist with at least 6 months of experience in US-guided blocks. For supraclavicular blocks the probe was placed in coronal-oblique-plane in the supraclavicular fossa and the puncture was in-plane (IP) from lateral to medial. For infraclavicular blocks the probe was placed parallel and below the clavicle and the puncture was out-of-plane. Ropivacaine 0.5% was administered up to a maximum of 0.5 ml x kg(-1) until appropriate US-guided-spread was achieved. Block duration and volumes of ropivacaine used (mean+/-1SD) in the supraclavicular approach were recorded. Success rate (mean +/- 1 SD, 95%confidence interval), complications rate and time to perform the block (two-tailed Student's test) were recorded both for supraclavicular and infraclavicular approaches. In the US-guided supraclavicular brachial plexus blocks, the duration of the sensory block was 6.5 +/- 2 h and of the motor block was 4 +/- 1 h. The volume of ropivacaine used in this group was 6 +/- 2 ml. In group I, 88% of blocks achieved surgical anaesthesia without any supplemental analgesia compared with 95% in group S (P = 0.39; difference=7%; 95% CI: -10% to 24%). Failures in group I were because of arterial puncture and insufficient ulnar or radial sensory block. Failures in group S were because of insufficient ulnar sensory block. No pneumothorax or Horner's syndrome was recorded in either group. The mean time (SD) to perform the block was in group I: 13 min (range 5-16) and in group S: 9 min (range 7-12); the 95% CI for this difference was 2-6 min and was statistically significant (P < 0.05). (i) Ultrasound-guided supraclavicular and infraclavicular brachial plexus blocks are effective in children. (ii) There has been no pneumothorax in 40 US-guided supraclavicular brachial plexus blocks performed by anaesthesiologists already trained in US-guided regional anaesthesia using an IP technique in children > or =5 years old. (iii) In this study, the supraclavicular approach of the brachial plexus was faster to perform than the infraclavicular one.

Background: Adjuvants to local anesthetics have been used to prolong the duration of analgesia after brachial plexus block surgery. This study evaluates the effects of adding magnesium sulfate and fentanyl with ropivacaine in the supraclavicular brachial plexus block to prolong the duration of analgesia. Aims and Objectives: The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and post-operative side effects if any, provided by magnesium sulfate and fentanyl as adjuvants to ropivacaine in supraclavicular block. Materials and Methods: A total of 80 patients with American Society of Anesthesiologists Grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group M received 30 ml of 0.5% ropivacaine with 250 mg magnesium sulfate and Group F received 30 ml of 0.5% ropivacaine with 50 μg fentanyl for supraclavicular brachial plexus block using PNS guidance. The onset and duration of sensory and motor block, time for the requirement of rescue analgesia, and adverse events during the perioperative period were noted. Results: Onset of sensory block. In group M, the mean onset of sensory blockade was 8.91±1.11 min and in Group F, the mean onset of sensory blockade was 12.12±1.14 min. The mean onset of motor block was 11.57±1.62 min in Group M, and 15.17±1.43 min in Group F. Duration of sensory block is 432.9±38.24 min in Group M and 553.45±39.91 min in Group F, respectively, Duration of motor block in Group M is 392.55±35.22 min and in Group F is 517±44.51 min which was statistically significant. Conclusion: Fentanyl prolonged the duration of sensory and motor block and duration of postoperative analgesia as compared to magnesium sulfate when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and was not associated with any major adverse events.

Background: Adjuvants to local anesthetics have been used to prolong the duration of analgesia after brachial plexus block surgery. This study evaluates the effects of adding magnesium sulfate and fentanyl with ropivacaine in the supraclavicular brachial plexus block to prolong the duration of analgesia. Aims and Objectives: The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and post-operative side effects if any, provided by magnesium sulfate and fentanyl as adjuvants to ropivacaine in supraclavicular block. Materials and Methods: A total of 80 patients with American Society of Anesthesiologists Grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group M received 30 ml of 0.5% ropivacaine with 250 mg magnesium sulfate and Group F received 30 ml of 0.5% ropivacaine with 50 μg fentanyl for supraclavicular brachial plexus block using PNS guidance. The onset and duration of sensory and motor block, time for the requirement of rescue analgesia, and adverse events during the perioperative period were noted. Results: Onset of sensory block. In group M, the mean onset of sensory blockade was 8.91±1.11 min and in Group F, the mean onset of sensory blockade was 12.12±1.14 min. The mean onset of motor block was 11.57±1.62 min in Group M, and 15.17±1.43 min in Group F. Duration of sensory block is 432.9±38.24 min in Group M and 553.45±39.91 min in Group F, respectively, Duration of motor block in Group M is 392.55±35.22 min and in Group F is 517±44.51 min which was statistically significant. Conclusion: Fentanyl prolonged the duration of sensory and motor block and duration of postoperative analgesia as compared to magnesium sulfate when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and was not associated with any major adverse events.

Background Brachial plexus block is a well-studied method of providing reliable anesthesia or analgesia for the upper extremity. Many approaches for brachial plexus block are present. These approaches are classified according to the level of local anesthetic injection into interscalene, supraclavicular, infraclavicular, and axillary blocks. By providing a rapid onset of dense anesthesia of the arm with a single injection, the supraclavicular block is perfect for operations involving the arm and forearm, from the distal humerus down to the hand. Ultrasound guidance has resulted in a better practice of supraclavicular approach to the brachial plexus, with decreasing the risk of complications. There has always been a search for adjuvants to local anesthetics used in regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. Objective To compare the effect of nalbuphine as an additive to bupivacaine versus bupivacaine alone in supraclavicular brachial plexus block with ultrasound guidance in upper limb surgeries regarding onset and duration of sensory and motor blocks, duration of analgesia, and postoperative analgesic requirements, as well as the effects on hemodynamics and possible complications with each technique. Patients and methods This study was carried out in Alexandria Main University Hospital on 50 adult patients of both sexes, American Society of Anesthesiology I and II, scheduled for surgeries of the hand and forearm under supraclavicular brachial plexus block with ultrasound guidance. Patients were randomly categorized into two equal groups (25 patients each) using the sealed envelope technique. Group I patients received bupivacaine only for the block, and group II patients received bupivacaine and nalbuphine as an adjuvant for the block. Results The results of our study showed that patients in nalbuphine group (group II) had significantly longer sensory and motor blocks duration, with longer duration of postoperative analgesia, when compared with patients in group I, who were received bupivacaine only for the block. Conclusion Coadministration of nalbuphine with bupivacaine in supraclavicular brachial plexus block leads to a significant increase in the duration of sensory and motor blocks and provides prolonged postoperative analgesia without causing adverse hemodynamic instability.

Introduction: Supraclavicular block is a common regional anaesthetic technique for upper limb surgeries. Adjuvants like dexamethasone and dexmedetomidine can enhance the block’s efficacy and prolong the duration of anaesthesia and analgesia. Aim: To compare the effects of perineural dexamethasone versus perineural dexmedetomidine added to a local anaesthetic mixture in supraclavicular brachial plexus block for upper limb surgeries. Materials and Methods: This interventional study was conducted in the Department of Anaesthesiology at Dhiraj Hospital, Vadodara, Gujarat, India from October 2023 to April 2024 on 80 patients with American Society of Anaesthesiologists (ASA) physical status I and II, aged 18 to 65 years, scheduled for surgery under supraclavicular brachial plexus block. Patients were allocated into two groups of 40 patients each. Group 1 received 12 mL of 0.2% lignocaine with adrenaline and 13 mL of 0.5% bupivacaine along with dexmedetomidine 50 mcg. Group 2 received the same local anaesthetic mixture with dexamethasone 8 mg (2 mL). The onset and duration of sensory and motor blocks, haemodynamic changes {variations in pulse, blood pressure, and oxygen saturation (SpO2 )}, duration of rescue analgesia, side-effects, and complications were evaluated. Chi-square test and t-test were applied for statistical evaluation. Results: Group 1 had a significantly lower average age (35.38±9.03 years) compared to Group 2 (46.40±13.12 years) (p=0.000039). Group 1 had a slower onset of sensory and motor blockade compared to Group 2 (14.38±2.19 minutes vs. 13.00±1.89 minutes, p=0.0036; 16.20±2.14 minutes vs. 15.70±1.99 minutes). Group 2 also showed significantly longer durations for motor blockade (918.75±65.80 minutes vs. 632.60±23.09 minutes, p=3.10×10-44), postoperative analgesia (1051.00±90.18 minutes vs. 811.12±17.23 minutes, p=1.00×10-28), and time for rescue analgesia (1116.75±93.96 minutes vs. 826.50±13.92 minutes, p=2.40×10-32). Haemodynamics and SpO2 were comparable between the two groups. Conclusion: Dexamethasone, as an adjuvant to a local anaesthetic mixture in supraclavicular brachial plexus block, provided excellent quality of postoperative analgesia with minimal side-effects. However, the incidence of hypotension and bradycardia was higher with dexmedetomidine, which could be managed with routine clinical measures.