الفهرس 
Anatomy of the Brachial PlexusOnly 14 pages are availabe for public view
 |  | from | 101 |  |  |
| | | from | 101 | | |
Abstract
Peripheral nerve block as an anesthetic technique plays an important role in modern regional anesthesia. Upper limb surgeries are mostly performed under peripheral blocks such as the brachial plexus block. Peripheral nerve blocks not only provide intra-operative anesthesia, but also extend analgesia in the post-operative period without major systemic side-effects by minimizing stress response and using minimal anesthetic drugs.
Regional nerve blockade avoids the unwanted effects of anesthetic drugs used during general anesthesia and beneficial for the patients with various cardiorespiratory comorbidities. In supraclavicular approach, the plexus is blocked where it is most compactly arranged at the level of the nerve trunks; as a result, a block with rapid onset can be achieved. Various adjuvants, including opioids, midazolam, magnesium sulfate, dexamethasone, and neostigmine, have been added to local anesthetics in an attempt to increase the duration of block and postoperative analgesia.
Ultrasound guidance has many advantages, as it can potentially improve the success rate up to 99%, fastens the onset time and reduce the risk of complications.
In our study we compared between fentanyl and dexmedetomidine as adjuvants to bupivacaine in supraclavicular brachial plexus block as regards the onset and duration of the sensory and motor block as well as side effects.
Fifty patients were included in this prospective, randomized, controlled, double blind study. Patients were randomly divided into two groups. Patients of group I (BD group) received 30 ml of bupivacaine 0.25% with dexmedetomidine 1 μg/kg while patients of group II (BF group) received 30 ml of bupivacaine 0.25% with fentanyl 1 μg /kg into the supraclavicular brachial plexus block.
The two groups were compared regarding their demographic data (age, sex and body weight), the duration of surgery, onset and duration of sensory block and onset and duration of motor block. The duration of analgesia of the brachial plexus block was recorded. Hemodynamics were monitored through the operation. Observation of any side effects was done. Data were collected for each patient and statistical analysis was done.
The present study showed that addition of dexmedetomidine to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of both sensory and motor blocks and significantly prolonged their duration compared to fentanyl. Also dexmedetomidine prolonged the analgesia of brachial plexus block as well as postoperative analgesia with subsequent consumption of fewer amounts of analgesics.The use of ultrasonography in performing the supraclavicular nerve block abolished nearly the incidence of complication such as pneumothorax or intravascular injection.
To conclude, we would like to state that dexmedetomidine prolongs the duration of sensory and motor block as compared with fentanyl when used as an adjuvant to bupivacaine in peripheral nerve block. Dexmedetomidine also increase time to first analgesic use, and decreases total analgesic use with no side-effects.