Comparison of Postoperative Analgesic Efficacy of 0.25% Ropivacaine with Dexmedetomidine versus Dexamethasone as an Adjuvant in Bilateral Superficial Cervical Plexus Block for Midline Neck Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Effective postoperative pain management following midline neck surgeries remains challenging. Regional anaesthetic techniques such as Bilateral Superficial Cervical Plexus Block (BSCPB) with adjuvants have emerged as valuable components of multimodal analgesia. Aim: To compare the postoperative analgesic efficacy of 0.25% ropivacaine with dexmedetomidine versus dexamethasone as adjuvants in BSCPB for midline neck surgery under general anaesthesia. Materials and Methods: The present randomised clinical study was conducted at Dhiraj Hospital, vadodara, Gujarat, India, from October 2023 to April 2025. Sixty patients aged 18-65 years undergoing elective midline neck surgery under general anaesthesia were randomly allocated into two groups: Group A (dexmedetomidine) received 19 mL of 0.25% ropivacaine with 50 mcg 0.5 mL dexmedetomidine plus 0.5 mL of 0.9% normal saline, while group B (dexamethasone) received 19 mL of 0.25% ropivacaine with 4 mg dexamethasone in 1 mL. Parameters assessed included intraoperative haemodynamics, Visual Analogue Scale (VAS) pain scores, Ramsay sedation scores, time to first rescue analgesia, duration of analgesia and total analgesic consumption in 24 hours. Data were analysed using unpaired student’s t-test for numerical variables and Chi- square test for categorical variables. Statistical significance was set at p<0.05. Results: The demographic data was comparable in both groups. From five minutes onwards throughout the intraoperative period, heart rate and blood pressure values were significantly lower in group A than group B, (p<0.0001). Postoperative VAS scores were consistently lower at 4 and higher at 22 and 24 hours with group A (1.57±0.5, 2.23±0.68 and 2.37±0.81) than group B (1.87±0.35, 1.73±0.52 and 1.77±0.43), respectively, (p<0.001). Duration of analgesia was 1417.93±116.07 minutes and 1131.97±78.13 minutes, time to rescue analgesia (1424.27± 116.07 vs. 1134.07±79.39 minutes, and Number of analgesic doses in 24 hours was 1.64±0.70 vs. 2.48±0.77 in group A and group B, respectively, p<0.0001. Ramsay sedation scores at 0 hour were 2.97±0.18 and 2.77±0.43 in group A and group B, respectively, p=0.0222. Conclusion: Both dexmedetomidine and dexamethasone are effective adjuvants to ropivacaine in BSCPB for midline neck surgery. Dexmedetomidine provide significantly longer overall duration of analgesia but is associated with more pronounced haemodynamic effects. The choice should be individualised based on patient characteristics and clinical priorities.