{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:58Z","timestamp":1786125898928,"version":"build-2736575974"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine Siriraj Hospital","award":["R016332026"],"award-info":[{"award-number":["R016332026"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In this double-blind, randomized controlled trial, we compared the efficacy of perineural 2 \u00b5g\/kg dexmedetomidine and 5 mg dexamethasone as adjuvants to bupivacaine for postoperative pain control in patients undergoing arthroscopic shoulder surgery. We hypothesized that the combination of bupivacaine with dexmedetomidine would prolong analgesia compared with dexamethasone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One hundred twelve patients scheduled for arthroscopic shoulder surgery were randomized to receive 15 mL of 0.33% bupivacaine with either 2 \u00b5g\/kg of dexmedetomidine or 5 mg of dexamethasone during ultrasound-guided interscalene brachial plexus block (ISB). The primary outcome was the duration of analgesia (DOA), analyzed as a time-to-event variable using Kaplan\u2013Meier survival curves with log-rank testing. Secondary outcomes included the duration of sensory block (DOS) and motor block (DOM), pain scores, incidence and severity of rebound pain, opioid consumption, patient satisfaction, and adverse effects. Longitudinal pain scores were evaluated using a regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 112 randomized patients, 107 were included in the primary analysis. Dexmedetomidine and dexamethasone produced a similar DOA (median, 16.77 vs 12.48 h; median difference in location 5.24 h, 95% CI \u22120.47 to 9.17; p\u2009=\u20090.655). The dexmedetomidine group had a significantly longer DOS (19.8 vs. 17.3 h; mean difference 2.45 h, 95% CI 0.23 to 4.65; p\u2009=\u20090.031) and DOM (19.9 vs. 17.8 h; median difference in location 2.23 h, 95% CI 1.02 to 3.60; p\u2009=\u20090.008). Postoperative pain score at 6, 12, 18, and 24 hours were comparable, as were rebound pain, postoperative nausea and vomiting (PONV), patient satisfaction, and opioid consumption. The dexmedetomidine group had a higher incidence of intraoperative hypotension (risk difference [RD] 44.4%, 95% CI 30.0% to 59.9%; p\u2009&lt;\u20090.001), bradycardia in the block room (RD 17.9%; p\u2009=\u20090.010) and intraoperatively (RD 27.6%; p\u2009=\u20090.004), and postoperative sedation (RD 10.9%; p\u2009=\u20090.027); however, all hemodynamic events were transient and did not require intensive care admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Perineural dexmedetomidine (2 \u00b5g\/kg) was not shown to be superior to dexamethasone (5 mg) in prolonging analgesia when added to bupivacaine for ISB in arthroscopic shoulder surgery. Although dexmedetomidine prolonged sensory and motor block duration, this did not translate into a longer DOA and was associated with higher rates of hemodynamic instability and sedation. These findings suggest limited clinical benefit and raise safety concerns regarding higher dexmedetomidine doses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353121","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:21:36Z","timestamp":1786123296000},"page":"e0353121","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["High-dose dexmedetomidine versus dexamethasone supplementation to interscalene brachial plexus block in arthroscopic shoulder surgery: A randomized, controlled trial"],"prefix":"10.1371","volume":"21","author":[{"given":"Thirada","family":"Srinil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busara","family":"Sirivanasandha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pathom","family":"Halilamien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawinee","family":"Pangthipampai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerattikul","family":"Phumchaitheerachort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patcharaon","family":"Sangjak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9257-7605","authenticated-orcid":true,"given":"Suppachai","family":"Poolsuppasit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"issue":"3","key":"pone.0353121.ref001","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1093\/bja\/aeh071","article-title":"Analgesia for day-case shoulder surgery","volume":"92","author":"AT Wilson","year":"2004","journal-title":"Br J Anaesth"},{"issue":"11","key":"pone.0353121.ref002","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/EJA.0000000000000248","article-title":"Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: A meta-analysis of randomised controlled trials","volume":"32","author":"TM Huynh","year":"2015","journal-title":"Eur J Anaesthesiol"},{"issue":"3","key":"pone.0353121.ref003","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/bja\/aet417","article-title":"Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: A systematic review and meta-analysis of randomized trials","volume":"112","author":"S Choi","year":"2014","journal-title":"Br J Anaesth"},{"issue":"3","key":"pone.0353121.ref004","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1213\/ANE.0000000000003860","article-title":"Dexamethasone is superior to dexmedetomidine as a perineural adjunct for supraclavicular brachial plexus block: Systematic review and indirect meta-analysis","volume":"128","author":"E Albrecht","year":"2019","journal-title":"Anesth Analg"},{"issue":"1","key":"pone.0353121.ref005","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s12630-017-0989-7","article-title":"Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: A randomized controlled trial","volume":"65","author":"D Holland","year":"2018","journal-title":"Can J Anaesth"},{"issue":"6","key":"pone.0353121.ref006","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1097\/AAP.0000000000000817","article-title":"Perineural low-dose dexamethasone prolongs interscalene block analgesia with bupivacaine compared with systemic dexamethasone: A randomized trial","volume":"43","author":"RL Kahn","year":"2018","journal-title":"Reg Anesth Pain Med"},{"issue":"23","key":"pone.0353121.ref007","article-title":"Which is your choice for prolonging the analgesic duration of single-shot interscalene brachial blocks for arthroscopic shoulder surgery? intravenous dexamethasone 5\u200amg vs. perineural dexamethasone 5\u200amg randomized, controlled, clinical trial","volume":"95","author":"EH Chun","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0353121.ref008","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1213\/ANE.0000000000002488","article-title":"Optimal dose of perineural dexamethasone to prolong analgesia after brachial plexus blockade: A systematic review and meta-analysis","volume":"126","author":"KR Kirkham","year":"2018","journal-title":"Anesth Analg"},{"issue":"2","key":"pone.0353121.ref009","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/aas.14002","article-title":"Alpha(2) -receptor agonists as adjuvants for brachial plexus nerve blocks - A systematic review with meta-analyses","volume":"66","author":"JH Andersen","year":"2022","journal-title":"Acta Anaesthesiol Scand"},{"issue":"4","key":"pone.0353121.ref010","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000005846","article-title":"Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials","volume":"96","author":"Y Ping","year":"2017","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"pone.0353121.ref011","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/bja\/aew411","article-title":"Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: A systematic review and meta-analysis of randomized controlled trials","volume":"118","author":"L Vorobeichik","year":"2017","journal-title":"Br J Anaesth"},{"issue":"3","key":"pone.0353121.ref012","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.redar.2016.07.005","article-title":"Postoperative analgesia with dexmedetomidine in interscalene block. 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0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block","volume":"36","author":"N Singh","year":"2020","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"pone.0353121.ref035","doi-asserted-by":"crossref","first-page":"998","DOI":"10.21474\/IJAR01\/10393","article-title":"A comparative study of dexmeditomedine and dexamethasone as adjuvants to local anesthetics in brachial plexus block for upper limb surgeries","volume":"8","author":"A Vinisha","year":"2020","journal-title":"Int J Adv Res"},{"issue":"2","key":"pone.0353121.ref036","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4038\/slja.v28i2.8574","article-title":"Comparison of ultrasound guided interscalene brachial plexus block using 0.2% ropivacaine with dexmedetomidine and 0.2% ropivacaine with dexamethasone - A prospective observational study","volume":"28","author":"M Shekar","year":"2020","journal-title":"Sri Lankan J Anaesthesiol"},{"key":"pone.0353121.ref037","article-title":"Randomized 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