الفهرس 
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Abstract
After approval of the ethical committee, this prospective controlled, comparative study was performed in Sohag University Hospital from May 2018 till November 2018 on 60 patients who were scheduled for forearm or hand surgery of either sex, aged 17-75 years old, under supraclavicular brachial plexus block guided by ultrasound and informed consent from each case was obtained. Patients divided into 3 groups:
• group C: received 25 ml bupivacaine 0.375% perineurally.
• group M: received 25 ml bupivacaine 0.375% + 200 mg Mg Sulphate perineurally.
• group F: received 25 ml bupivacaine 0.5%-20 ml+ 50 μg Fentanyl perineurally.
As regard onset of sensory block there was no statistically significant difference between the three studied groups. Also, it was not significantly faster in group C than group F and non-significantly faster in group M than group F (P=0.125),and group M than group C .
As regarding onset of motor block there was not significally difference between the three study groups . Also it was not significant difference in group C than group F & group M, non-significantly faster in group C & group M.
As regarding duration of sensory block there was there was a statistically significant difference between the three study groups . It was highly significant longer in group M compared with group C & but moderate significant between group M with group F .
As regarding duration of motor block there was significant difference between the three study groups. Also, it was highly significant longer in group M compared with group C & less significant group F.
For Postoperative pain assessment using Visual Analogue Scale(VAS) group C: In comparison with base line there was a highly significant increase in the VAS at 6 hrs,8hrs,18hrs and 24hrs postoperative.
group M: In comparison with base line there was a mild significant inrease in the VAS at 8hrs postoperative and a highly significant increase at 18hrs and 24hrs postoperative.
group F: In comparison with base line there was a significant increase in the VAS at 18hrs and 24hrs postoperative.
Between the three study groups: there was a significant difference in VAS between the three studied groups at 8hrs ,12hrs ,18hrs postoperative and a mild significant difference at 24hrs postoperative.
Between group C, M: there was a significant increase in VAS between the three studied groups at 8hrs postoperative a significant increase at 12hrs postoperatively and a less significant increase at 18 hrs. postoperative.
Between group C, F: there was a significant difference in VAS between the three studied groups at 6hrs ,8hrs ,12hrs ,18hrs postoperative and a significant difference at 24hrs postoperative.
Between group M, F: there was a significant difference in VAS between the three studied groups at 12hrs postoperative and a less significant difference at 18hrs postoperative.
As regarding first request of rescue analgesia there was a significant difference between the three study groups. Also, it was significant later in group F than group C & group M and less significant later in group M than with group C.
As regarding total rescue analgesic dose given there was a significant difference between the three study groups. Also, it was a less significant difference in group F than group C, mildly significant smaller in group B than group C and in group F than group M.
Conclusion
In our study we concluded that supraclavicular block is a safe technique which has many advantages. Our study demonstrates that both mg sulphate and fentanyl as additives for supraclavicular brachial plexus block hastens most of properties of block like onset of sensory block, motor block and provides a longer duration of motor blockade and postoperative analgesia as compared to control group in which patients received local anathetic only. As comparison between mg sulphate and fentanyl, mg sulphate as additive to local anathetic in block, as onset of block mg sulpahte makes the onset of block faster than fentanyl which makes the onset even slower than block with local anathetic alone. As regard duration of block both mg sulphate and fentanyl increase duration of block than block with only local anathetic but mg sulphate makes the duration longer than fentanyl. As regard analgesia both of them increase time of analgesia postopertively but Fentanyl increases time of analgesia more than mg sulphate. As regard complications and side effects both of them as additives has no effect in incidence of complications or side effects of block.