Dexmedetomidine Plus Ropivacaine versus Ropivacaine Alone for Interscalene Brachial Plexus Block in Shoulder Surgery: Evidence from a Systematic Review and Meta-analysis

Ilsyafitri  Bonita; Zulkifli; Rizky Dani

doi:10.64531/7femvd90

Authors

Ilsyafitri Bonita Department of Anesthesiology and Intensive Care, Palembang BARI General Hospital, Palembang, Indonesia Author
Zulkifli Staff Lecturer, Department of Anesthesiology and Intensive Care, Muhammad Hoesin Hospital, Palembang, Indonesia Author
Rizky Dani Fellowship of Intensive Care, Muhammad Hoesin Hospital, Palembang, Indonesia Author

DOI:

https://doi.org/10.64531/7femvd90

Keywords:

Dexmedetomidine, Ropivacaine, Interscalene brachial plexus block, Shoulder surgery, Meta-analysis

Abstract

Introduction: Shoulder surgery is associated with significant postoperative pain that often hinders rehabilitation. Interscalene brachial plexus block (ISB) with ropivacaine provides effective analgesia, but its limited duration necessitates adjuvants. Dexmedetomidine, a selective α₂-adrenergic agonist, has been proposed to enhance block quality and prolong analgesia. Objective: To evaluate the efficacy and safety of adding perineural dexmedetomidine to ropivacaine for ISB in patients undergoing shoulder surgery. Methods: A systematic search of PubMed, Cochrane Library, and ScienceDirect was conducted up to [insert date]. Randomized controlled trials comparing ropivacaine with versus without perineural dexmedetomidine in adult patients receiving ISB for shoulder surgery were included. The primary outcome was postoperative pain at 8–12 hours. Secondary outcomes included block onset and duration, opioid consumption, and adverse events. Risk of bias was assessed with the Cochrane RoB 2 tool. Pooled results were analyzed using random-effects models. Results: Five RCTs involving 261 patients were included. Dexmedetomidine combined with ropivacaine significantly reduced 8–12 hour pain scores (MD −1.82, 95% CI −2.47 to −1.16; p < 0.00001), prolonged sensory and motor block, and reduced postoperative opioid consumption. Heterogeneity was moderate-to-high (I² = 83%), largely due to differences in dexmedetomidine doses and ropivacaine concentrations. Adverse events such as bradycardia and hypotension were more common at higher doses, but no major complications were reported. Discussion: Dexmedetomidine provided clinically meaningful analgesic benefits, exceeding the minimal clinically important difference, but required careful dosing to avoid cardiovascular side effects. Conclusion: Perineural dexmedetomidine enhances the efficacy of ropivacaine in ISB for shoulder surgery, offering superior analgesia and opioid-sparing effects. Further studies should refine optimal dosing and long-term outcomes.

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