الفهرس 
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Abstract
1908, a German surgeon professor august Bier, introduced an anesthesia method which is nowadays called IVRA or Bier’s block. IVRA is a simple, safe and economic technique for short timed upper limb surgeries. The main problem of IVRA is that the required local anesthetic dose is very close to toxic dose. Many attempts have been done to
overcome this problem as giving a mixture of small doses of two local
anesthetics or giving small dose of local anesthetic and potentiating its
effect by alkalinization or addition of adjuvants such as opioids, neostigmine, NSAIDs, alpha adrenergic agonist, ketamine or muscle relaxants. The aim of this work is to evaluate the effect of nitroglycerine or dexamethasone on intraoperative and postoperative analgesia, sensory and motor block onset times, and tourniquet pain when added to lidocaine compared to lidocaine alone for intravenous regional anesthesia in upper limb surgery. Lidocaine is amide type local anesthetic of moderate potency and
duration but of good penetrating power and rapid onset and effective by
all routs of administration. Nitroglycerin is a strong direct vasodilator that relaxes all vascular
smooth muscle, especially venous beds.