Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Erector Spinae Plane Block for Acute Pain Management in Patients With Traumatic Rib Fractures

Traumatic rib fractures cause severe chest wall pain that can impair normal breathing, coughing, and lung function. While systemic opioids are commonly used to treat traumatic pain, their side effects, such as sedation and respiratory depression, can complicate recovery. Regional nerve blocks like the ultrasound-guided erector spinae plane block (ESPB) offer targeted pain relief while minimizing opioid requirements.

The purpose of this clinical trial is to compare the analgesic efficacy and respiratory outcomes of adding dexmedetomidine versus dexamethasone to bupivacaine during an ultrasound-guided ESPB in emergency department patients with acute traumatic rib fractures.

Participants aged 18 to 65 years presenting within 24 hours of rib injury will be randomly assigned to one of two groups:

* Dexmedetomidine Group: Receives an ultrasound-guided ESPB with bupivacaine plus dexmedetomidine. * Dexamethasone Group: Receives an ultrasound-guided ESPB with bupivacaine plus dexamethasone.

The primary outcome is the duration of analgesia, measured as the time to the first request for rescue pain medication. Secondary outcomes include pain scores at rest and during coughing/deep breathing, total 24-hour opioid consumption, diaphragmatic motion evaluated by ultrasound, respiratory recovery, and the incidence of adverse events over a 24-hour follow-up period.

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Key information

Conditions

Rib Fractures Acute Pain Fractures, Bone Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms Thoracic Injuries Thoracic Trauma Wounds and Injuries

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2 / Phase 3

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Adult patients aged 18 to 65 years
Both sexes
American Society of Anesthesiologists (ASA) physical status I-II
Acute traumatic rib fractures confirmed by appropriate imaging
Flail-chest patients who are hemodynamically and respiratory stable to undergo erector spinae plane block (ESPB) and reliable assessment
Spontaneously breathing patients or patients receiving supplemental oxygen/non-invasive respiratory support without an immediate indication for intubation
Ability to report pain using a Numeric Rating Scale (NRS)
Presentation within 24 hours of trauma
Ability to provide written informed consent

Exclusion criteria

Patient refusal to participate
Immediate need for endotracheal intubation or invasive mechanical ventilation prior to randomization or block placement
Hemodynamic instability requiring immediate resuscitation or vasopressor support precluding safe regional anesthesia
Cardiorespiratory arrest or peri-arrest status
Severe associated traumatic brain injury or other injuries preventing reliable clinical evaluation
Major associated injury requiring immediate emergency operative or interventional procedures that prevent protocol completion
Coagulopathy or any contraindication to regional anesthesia
Local infection at the anticipated block needle insertion site
Known allergy to amide local anesthetics, dexmedetomidine, or dexamethasone
Significant bradyarrhythmia, high-grade atrioventricular block, or contraindication to dexmedetomidine
Chronic opioid consumption or chronic pain syndromes requiring regular analgesic therapy
Prior regional anesthesia performed for the current trauma
Inability to cooperate with the procedure or pain evaluation

Treatment and study plan

Dexmedetomidine with Bupivacaine in ESPB

Drug

Ultrasound-guided thoracic erector spinae plane block (ESPB) administered deep to the erector spinae muscle and superficial to the transverse process (typically T4-T6) using bupivacaine supplemented with dexmedetomidine (0.5 mcg/kg) following local skin infiltration with 5 mL of 2% lidocaine.

Dexamethasone with Bupivacaine in ESPB

Drug

Ultrasound-guided thoracic erector spinae plane block (ESPB) administered deep to the erector spinae muscle and superficial to the transverse process (typically T4-T6) using bupivacaine supplemented with dexamethasone (4 mg) following local skin infiltration with 5 mL of 2% lidocaine.

Primary outcomes

Time to First Rescue Analgesic Request

Time frame: Up to 24 hours post-block

Time (in minutes) from the completion of the ultrasound-guided erector spinae plane block until the patient's first request for rescue analgesia (or when the Numeric Rating Scale score is 4 or greater).

Sponsors and collaborators

Lead sponsor

Assiut University

Other

Registry information

Official study title

Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Erector Spinae Plane Block for Acute Pain Management in Patients With Traumatic Rib Fractures: A Prospective Randomized Double-Blind Controlled Study

Important dates

Study start: 2026
Primary completion: 2027
Study completion: 2027
First posted: Sep 18, 2026
Registry last updated: Sep 18, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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