الفهرس 
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Abstract
Ultrasound guidance has the advantage of real time identification of the neural plexus anatomy, and directly determines the spread of local anesthetic within the plexus sheath.
This study was carried out on 69 adult patients undergoing upper limb surgery, and supraclavicular brachial plexus block was done for all patients with aid of ultrasound, neurostimulation or both combined techniques as following:
Group I: the block is done with neurostimulation.
Group II: the block is done with ultrasound.
Group III: the block is done with ultrasound and confirmed by neurostimulation.
Patients received bupivacaine 0.4ml/kg 0.5%.
Assessment was made in the following way:
The characteristics of analgesia were evaluated by visual analogue scale.
Sensory loss was assessed by loss of response to pinprick.
The degree of motor block was evaluated by three point scale.
Measurements of hemodynamics (ECG, NIPB) and oxygen saturation were done.
Side effects and complications were evaluated.
Data analysis was done comparing the three groups and the following results were found:
Demographic data:There was no statistical significant difference between study groups as regard; age, weight and sex.
Easiness of the block: We found the time needed to perform supraclavicular brachial plexus block is shorter with neurostimulation, longer with ultrasound guidance and the longest with ultrasound guidance and confirmation with neurostimulation.
Quality of the block:
The onset of sensory blockade was earlier in group II than the other groups and the duration of sensory blockade was longer in group II.
We found that the mean difference in the onset and duration of motor block were highly statistically significant between group II and other groups.
Safety, side effects and complications:
We didn’t have complications at all with the use of ultrasound only.
Success, failure or partial block:
We found success rate is higher with the use of ultrasound alone to guide the block, we had success rate 100% after 2 years of training and we consider the block failed only when we use GA, so neurostimulation with ultrasound doesn’t improve the success rate of the block, but it decrease it.
Conclusion: The use of ultrasound in supraclavicular brachial plexus block improves the quality of sensory block and prolong the duration of sensory and motor block. Ultrasound guidance has higher success rate, greater safety and fewer complications.The use of neurostimulation with ultrasound has no advantage over ultrasound alone; even it has a lower success rate.