الفهرس 
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Abstract
This controlled randomized prospective study was carried out on thirty six adult patients aged (ASAI and II)of either both sex, scheduled for elective upper limb surgery. They were allocated into groups each consisted of 12 patients. All patients were premedicated by intravenous midazolam (2mg) one hour before surgery. Group B received axillary brachial plexus block using 40ml bupivacaine (0.5%) only. In group BT axillary brachial plexus block was done using 40 ml bupivacaine(0.5%) with 100mg tramadol. In group BK axillary brachial plexus block was done using 40 ml bupivacaine(0.5%) with 50mg ketamine. It can be concluded that 100mg tramadol but not 50mg ketamine enhances local anesthetic effect and prolongs duration of analgesia after axillary brachial plexus blockade when combined with bupivacaine. More over, ketamine induced many adverse effects. These finding raise doubts about the utility of ketamine with local anesthetic for axillary brachial plexus blockade.