الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Since the discovery of regional anaesthesia, there has been considerable interest in regional anaesthetic techniques particularly in peripheral nerve blockade (PNB). PNB can decrease the anaesthetic and analgesic requirements during surgery and reduce the need for opioid analgesics in the postoperative period. More effective pain relief in the early postoperative period from the residual sensory block provided by local anaesthesia can facilitate the recovery process, enabling early ambulation and discharge home.
Good postoperative analgesic management probably carries benefits other than increased patient comfort. The magnitude of the neuro-endocrine stress response, postoperative pulmonary complications and the incidence of myocardial ischemia can be decreased. Early mobilization can be achieved and the patient can be discharged from hospital sooner.
Ultrasound guidance has resulted in a resurgence of interest in the supraclavicular approach to the brachial plexus. The ability to image the plexus, rib, pleura, and subclavian artery with ultrasound guidance has increased safety due to better monitoring of anatomy and needle placement and so decreasing the risk of pneumothorax.
Of various local anaesthetics used for brachial plexus block, bupivacaine and lidocaine are amide local anaesthetic with different onset time and duration of action. Their mechanism of action is by preventing the generation and conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold.
The aim of the work was to is to determine the minimum effective anaesthetic volume required to produce an effective supraclavicular block for surgical anaesthesia using an ultrasound (US)-guided technique by comparing between three different volumes namely (15,20 and 30 ml of equal mixture of lidocaine2% and bupivacaine .5 % for upper limb surgeries and to compare between the three groups regarding to onset and duration of sensory and motor block, duration of analgesia, postoperative analgesic requirements and incidence of side effects .