الفهرس 
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Abstract
Surgical anesthesia of the upper limb, from the elbow to the hand, may be readily achieved by injection of local anesthetic around the brachial plexus. This regional anesthesia technique avoids the need for a general anesthetic and its accompanying risks (airway injuries, postoperative nausea and vomiting, postoperative drowsiness, etc). Control of postoperative pain is also excellent as the sensory block typically persists for several hours following injection.
Peripheral nerve blocks are almost always performed as blind procedures. The use of ultrasound appears to permit accurate deposition of the local anesthetic perineurally, and has the potential to improve the success and decrease the complications of infraclavicular brachial plexus block. α2-adrenergic (α2-AR) receptor agonists have been successfully used in several clinical settings in view of diverse actions which include sedation, analgesia, anxiolysis, perioperative sympatholysis, cardiovascular stabilizing effects, reduced anesthetic requirements, and preservation of respiratory function
Dexmedetomidine, is a selective α2-adrenoceptor agonist that is used as an adjuvant mixed with local anesthetics during regional anesthesia
Addition of opioids to local anesthetics has gained popularity. Opioids have multiple central neuraxial and peripheral mechanisms of analgesic action
Fentanyl is a mu opioid receptor agonist that has been used as adjuvant to local anesthetics to improve efficacy of peripheral nerve block
This study was carried out on 120 patients scheduled for elective and emergency forearm or hand surgery
The 120 patients were divided into three groups, 40 patients each, according to the local anesthetic mixture used:
• C group (control group): 25 ml bupivacaine 0.5% + 2 ml normal saline 0.9%
• D group (dexmedetomidine group): 25 ml bupivacaine 0.5% + 100 ug dexmedetomidine in 2 ml
• F group (fentanyl group): 25 ml bupivacaine 0.5% + 100ug fentanyl in 2 ml
The total volume of the local anesthetic mixture was equal (27 ml) for all patients.
A comparison was made between the three groups as regards motor and sensory block, duration and quality of postoperative analgesia, hemodynamic and respiratory variables as well as side effects during forearm or hand surgery under ultrasound guided Infraclavicular block.
Demographic data (age, sex, BMI) and operational data (duration of surgery) were statistically comparable among the three groups.
The present research revealed that infraclavicular brachial plexus block with 25ml 0.5% bupivacaine supplemented with 100μg dexmedetomidine significantly affect Block characteristics evident by shortened onset time of both sensory and motor block compared
with the same block supplemented by 100μg fentanyl and 0.5% bupivacaine in patients undergoing upper limb surgery. Also addition of dexmedetomidine significantly prolong time to complete sensory resolution and regression of motor block with prolonged analgesic effects of infarclavicular block evident by decreased postoperative pain scores (VAS), total analgesic consumption and prolongation of time to first request for analgesia.
No side effects requiring any intervention were noticed in either group. No patients in the study demonstrated any signs or symptoms of local anesthetic drug toxicity.
There were no serious postoperative complications in the three groups.
Ultrasound guided Infraclavicular block appears to be associated with a high success rate, short onset time, low complication rate and excellent analgesia even when a tourniquet was used. It was well tolerated by patients.