The goal of this clinical trial is to learn if there is a difference in morphine requirements in patients after upper extremity surgeries including shoulder arthroscopy. The main question it aims to answer is whether there is a difference between Interscalene brachial plexus blocks with the addition of buprenorphine, dexamethasone, and clonidine and the same block without the adjuvant.

This study will be a prospective randomized single-blinded clinical trial.

Patients undergoing shoulder arthroscopy who meet the inclusion criteria will be invited to participate in this study. A total of 120 patients will be recruited to participate.

Patients will be randomized via a 1:1 ratio to either the Interscalene block with the addition of buprenorphine, clonidine, dexamethasone group or Interscalene block alone group

The null hypothesis of this research study is that there will be no significant difference in morphine requirements between the Interscalene brachial plexus blocks with the addition of buprenorphine, dexamethasone, and clonidine and the same block without the adjuvant.

Inclusion Criteria:

• Patients ≥ 18 years old
• Patients undergoing shoulder arthroscopy
• Patients willing to participate and sign informed consent

Exclusion Criteria:

• Severe COPD/other contraindication to general anesthesia
• Patient with a weight of less than 60 kg
• Dementia, not alert or oriented to person, place, or time
• Chronic pain patient with daily opioid use at home.
• Patient with allergy to local anesthetics
• Patient refusal
• Total shoulder arthroplasty
• Concomitant pain in different area from operative site.
• Pregnancy
• Patient with active infection on the injection sites for the blocks
• Patients unable or willing to understand or comply with the study protocol