Clinical Research Directory

Inclusion Criteria: * • Patients' acceptance. * Age: Adults aged 21-65 years old. * BMI: 25-30 kg/m2 * Sex: both sexes (males or females). * Patients undergoing unilateral shoulder surgey under general anesthesia. * ASA (American Society of Anesthesiologists) physical status classification I to II. * Duration of the surgery \< 3hours. Exclusion Criteria: * • Patients with contraindications to regional anesthesia (e.g. local or systemic infections, or severe neurological or muscular or bleeding disorders or patient on anticoagulant). * Allergy to study medications: bupivacaine or dexamethasone, or dexmedetomidine * Patients with severe cardiovascular, respiratory, renal, or hepatic diseases, uncontrolled diabetes , or those undergoing chronic opioid therapy. * Psychiatric disorders that hinder informed consent or study participation. * history of neurological diseases or conditions that would affect the efficacy of nerve blocks (e.g., neuropathy, spinal cord injury, or history of severe muscle weakness). * Patients with nerve injury or disease around the shoulder joint, including thoracic outlet syndrome, Multiple sclerosis, cervical disc disease with ipsilateral radiculopathy, or patients with abnormal sensory or motor function of the upper limb.