الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Brachial plexus block is a useful alternative to general anesthesia for upper limb surgeries providing complete muscle relaxation, stable intraoperative hemodynamics and smooth transition to postoperative pain relief1. Hence the need of the hour today for postoperative analgesia is the one which requires minimum technical intervention and expertise, gives good quality of analgesia, requires easily available drugs and equipments, cost effective, and has least side effects thereby has good patient and surgeon acceptance. Midazolam a water soluble benzodiazepine has been used by various routes to prolong analgesia. The present study was undertaken to assess the analgesic efficacy of midazolam with bupivacaine in brachial plexus block ) Midazolam a water soluble, short acting benzodiazepine , produces analgesia by acting on gamma –amino butyric acid receptors (GABA). Extrasynaptic receptors for GABA are present on myelinated axons of peripheral nerves. Midazolam used with local anesthetics (LA) through various routes in many studies has been shown to prolong post-operative analgesia.
Imaging is playing an increasing role in many fields of medicine, the use of a Doppler ultrasound device to aid identification of the subclavian artery and vein before brachial plexus block by the supraclavicular approach with a success rate of 98% with no complications. In 1994, Kapral et al published the first paper using direct ultrasonographic visualization for a regional block (supraclavicular brachial plexus block) including the direct observation of the spread of the local anesthetic but the quality of the views remained poor due to inadequate resolution with the ultrasound technology used at that time. This is the only technique that sheds light on anatomical variations between individuals. The supraclvicular is very popular approach due to its efficacy; as the nerves are very tightly packed, so that the onset is fast and the blockade deep, leading to this technique being nicknamed “the spinal of the arm”, as The subclavian artery and the brachial plexus emerge from the interscalene groove and course laterally and inferiorly to pass under the clavicle. Here, the brachial plexus is comprised of a compact group of three trunks and is perhaps most susceptible to complete blockade with a single injection at this level It was traditionally performed for surgeries of the upper extremity below the shoulder. However, recently reported that ultrasound-guided supraclavicular blocks are effective and safe for shoulder arthroscopy.
The supraclavicular approach fell out of favour, largely due to the risk of pneumothorax, generally quoted at between 0.5% and 6%, The development of ultrasound visualization has led to a renewed interest in this approach for many upper limb procedures .
Complications of SCB: - pneumothorax & vascular injury which decreased up to 95% with ultrasound use.