الفهرس 
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Abstract
This prospective, randomized, double-blinded controlled study was conducted at EL- Minia university hospital during the period from December 2017 to november 2018 , the study involved 80 patients of either sex, of ASA I and II physical status, aged (18-80)years old , and posted for elective forearm surgeries, under ultrasound guided supraclavicular brachial plexus block and written informed consent from each patient was obtained.
Patients were randomly divided into two equal groups , Patients in group A (n= 40) received supraclavicular block using 25mL of 0. 5% bupivacaine and 1 mL normal saline and group B ( n =40) patients received 25 mL 0. 5% bupivacaine and 1 mL neostigmine (0.5mg).
Our objectives:
Were to compare and evaluate the onset and duration of sensory and motor block, post-operative analgesia and side effects when neostigmine in dose of 0.5 mg is added to bupivacaine given through ultrasound-guided supraclavicular brachial plexus blocks (BPB) in patient undergo forearm surgeries.
All patients were assessed with regards to:
Hemodynamics (heart rate , mean Bp ) and oxygen saturation were recorded preoperatively just before the block as a baseline value, immediately after the block 5, 20, 30,40,45 , 60 minutes during the operative time and 1, 2, 4, 6, 9 and 12 hours after end of operation.
Onset time of sensory block, Onset time of motor block, Duration of sensory block, and Duration of motor block.
Pain assessment using a scoring system based on the visual analogue pain scale(VAS) measured at the following time intervals 0, 2, 4, 6, 8, 12 and 24 post operatively, time to first analgesic requirement (in hours) and total analgesic consumption was monitored in the two groups for 24 hours in ward.
The incidence of adverse effects whether related to the drugs used in the technique or related to the technique itself were recorded.
The results of this study found that demographic (age, sex, weight and ASA classification and surgical duration were statistically insignificant between the two groups.
Hemodynamics (HR and mean Bp) were statistically significant between the groups .They were lower in Neostigmine groups.
As regard onset of sensory and motor block were clinically and significantly earlier in group B than group A ( p < 0,05) and the same for duration of sensory and motor block were clinically and significantly longer in group B than in group A ( P < 0,05 ).
Regarding Visual Analogue Pain Scale (VAS), while comparing the two groups, the differences were significant at 9 and 12 hours after surgery for the favor of the neostigmine groups .
The time to first analgesic request was significantly longer in group B than group A.
Failure of block occurred in 2 of the studied patients and they received general anesthesia and we were replaced by other patients and 1 patient in group (B) showed bradycardia and was treated effectively by atropine .
We conclude that neostigmine when used as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block has advantage over bupivacaine alone especially in the quality of sensory and provide safe and effective post operative analgesia in patients undergoing forearm surgeries these findings were obvious in dose of ( 0.5 mg).