الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Fractures of the forearm are extremely common and usually need manipulation immediately for reduction followed by operative intervention.Amongst various techniques, HB and IVRA are attractive options. However, while HB has been demonstrated to be safe simple and has been used effectively for treatment of radius fractures in ER and for immediate pain relief it isn’t sufficient for any operative intervention
IVRA is suitable for operations of the distal extremities but it is painful during exsanguination with nearly absent post operative analgesia.
Lidocaine is the most frequently used LA for IVRA and HB, Ketamine an IV anesthetic agenthave been implicated in perioperative pain management, and italso has local anesthetic qualities.
A combination of blocks is usually done to overcome the deficiencies of individual blocks and to improve operating conditions or to prolong post operative analgesia.
The aim of this study is to evaluate the effect of adding ketamine to IVRA versus adding it to HB in patients receiving combination of HB & IVRA for anesthetic management of fore arm fractures.
This interventional, controlled single blinded clinical trial was carried out in Assiut University Hospital. After approval from local ethicalcommittee and written informed consent from all participants, 44 patientswith closed fracture of distal upper extremity within 7 days, requiring closed reduction and internal fixation with k-wires were included.They were divided into two groups to receive ketamine (0.5mg/kg) either within HB (GroupA) or within IVRA (GroupB) for patients receiving combinded HB and IVRA.
The results of this study showed that both techniques wereefficient in Anaesthetic management of forearm fractures in terms ofNRS score, 1rst analgesic request time .the NRS score was sigificatlly lower in groupA during conduction of IVRA ,post operative analgesia time was aslosiginficantlly higher in group A. No significantdifferences were found as regard onset of HB or IVRA, hemodynamic parameters, intra- andpostoperative complications.
In conclustion:from the findings of the present study, adding ketamine to HB in patients receiving combination of HB & IVRA for anaesthetic management of fore arm fractures can provide good analgesia for conduction of IVRA and can prolong post operative analgesia better than adding it to IVRA.