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Comparison of the effect of three different adjuvants on the analgesic duration of single injection interscalene brachial plexus block: a prospective, randomized, triple blinded clinical trial
  1. Melinda S Seering,
  2. Emine O Bayman,
  3. Cynthia A Wong,
  4. Yatish Siddapura Ranganath and
  5. Anil A Marian
  1. Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  1. Correspondence to Dr Melinda S Seering, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; melinda-seering{at}


Background and objectives Use of regional anesthesia can result in faster recovery and better patient satisfaction. Addition of perineural adjuncts to local anesthetics may improve the duration of analgesia, but there is a paucity of data comparing them in a single randomized trial. We compared the effects of three adjuncts clonidine, dexamethasone, and buprenorphine, on the duration of analgesia of interscalene brachial plexus block.

Methods 160 patients, undergoing elective shoulder surgery, were randomized to four groups to receive an interscalene block with one of the following solutions: ropivacaine alone, ropivacaine with clonidine 75 µg, ropivacaine with dexamethasone 8 mg, or ropivacaine with buprenorphine 300 µg. The primary outcome variable was the duration of analgesia; secondary outcome measures were time to onset of the block, and the duration of sensory and motor blocks.

Results There was no statistically significant difference in the total analgesia time among the four groups; p=0.11. The pairwise comparison in analgesic time and 99% CI were: control versus clonidine (−1.94 hours (−7.33 to 3.12)), control versus dexamethasone (−4.16 hours (−9.50 to 0.58)) and control versus buprenorphine (−1.1 hours (−5.34 to 3.23)). There was no differences in block set-up time, or total sensory and motor block duration among the groups.

Conclusion There was no significant improvement in the duration of analgesia with addition of any of the three adjuncts to interscalene blocks. However, there was a larger than expected variability in patient response, hence the study may have been underpowered for the primary outcome.

  • brachial plexus
  • pharmacology:local anesthetics
  • pre-emptive analgesia

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  • Contributors MSS conceived and created the study protocol, implemented and performed the study, collected the data, performed the analysis, and wrote the paper. EOB helped create the study protocol, analyze the data, and edited the paper. CAW helped perform data analysis and wrote and edited the paper. YSR helped with the implementation and performance of the study and data collection. AAM helped with the implementation and performance of the study, performed data analysis, and wrote and edited the paper.

  • Funding Departmental Funding: Department of Anesthesia, University of Iowa Carver College of Medicine.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval University of Iowa Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.