الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
This study was carried out after approval of ethical committee in sohag university hospital, and written informed consent from the patient. 50 patients aged 16-60 years with ASA I- II who were scheduled for upper limb surgeries under ultrasound guided supraclavicular brachial plexus block were enrolled in the study.
The aim of our study was to compare between midazolam versus tramadol when added to bupivacaine in ultrasound guided supraclavicular brachial plexus block for anesthesia in upper limb surgeries.
The patients were randomly allocated to two groups, 30 patients each:
group M (midazolam group): Patient received 30 ml of 0.375% bupivacaine plus 50mic/kg midazolam in 2 ml saline.
group T (Tramadol group): Patient received 30 ml of 0.375 bupivacaine plus 1 mg/kg tramadol in 2 ml.
After institution of the blockade , the onset time of sensory and motor block was recorded. The surgery was allowed to proceed and when complete anesthesia was achieved. Intra operatively HR, MBP, SPO2 were monitored every 5 minute.
Post operatively, the following parameters were assisted: duration of sensory and motor block, VAS score were assessed at 4, 8, 16, 18, 19, 20, 21, 22, 23, 24hr,the first request for analgesics and total pethidine dose was documented.
The result of our study demonstrated that addition of midazolam to bupivacaine resulted in significant prolongation of duration of post-operative analgesia, lower analgesic consumption and lower incidence of adverse effects.
The use of ultrasound helped us in good localization of brachial plexus and prevented occurrence of major complications.
Conclusion
The addition of midazolam to bupivacaine resulted in significant prolongation of duration of post-operative analgesia, lower analgesic consumption and lower incidence of complications.
The use of ultrasound helped us in good localization of brachial plexus and prevented occurrence of major complications.
Future research has to explain the mechanisms by which regional anesthesia can confer improved outcomes before firm conclusions can be drawn. Epidemiologic research has to clarify what the barriers to the use of regional anesthesia, and more focused research on the effect of regional anesthesia in subpopulations is also needed as risks and benefits may not be uniformly distributed among surgical procedures and patient groups. Until these questions are answered, anesthesiologists should strongly consider the use of regional anesthesia and find comfort in the fact that little evidence exists that its use is associated with inferior outcomes compared to its alternatives.