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

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