الفهرس 
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Abstract
In an attempt to improve perioperative analgesia, a variety of additives have been administered concomitantly with local anesthetics into the brachial plexus sheath. Calcium ions have an important role in the analgesia mediated by local anesthetics . Calcium permeability is reduced by local anesthetics, the clinical investigations have shown that verapamil can potentiate the analgesic effect of local anesthetics . The aim of this study was to asses the role of verapamil in potentiating the analgesia provided by lidocaine with or without sufentanil , and to determine the hemodynamic effects and complications of verapamil administered in brachial plexus blockade during and after upper limb surgery. This study was conducted on eighty adult patients of either sex, aged between 20 - 50 years old , weighed 50 - 80 Kg and of ASA I , II or III subjected to orthopedic, vascular or general surgical procedures below the elbow. An axillary catheter was inserted and patients were randomly allocated into four groups 20 patient according to the drugs used. Group L received 30 ml Lidocaine 1.5 % only, Group LV received Lidocaine + 2.5 mg Verapamil , Group LS received Lidocaine + 0.2 g/kg Sufentanil, Group LVS received Lidocaine + 2.5 mg Verapamil + 0.2 g/kg sufentanil. After completion of the surgical procedure , evaluation of the nerve block was performed every 15 min until complete sensory recovery occurs. Postoperatively , patients were asked to qualify their pain on a verbal pain score between 0 and 10 (with 0 representing no pain and 10 the worst imaginable pain). The pain scores was recorded at 1, 2, 6, 12 and 24 hours after completion of the surgical procedure. Haemodynamic and blood gasometry were measured intraoperatively and at1, 2, 6, 12 and 24 hours postoperatively.Serum glucose and cortisol level were assessed preoperatively and 2 h postoperatively. Any side effects as pruritis , hypotension or bradycardia was recorded. There were no significant differences between groups regarding age, body weight, and the mean operative duration .There was a significantly faster onset of sensory block in group LVS (12 10 minutes) when compared with groups L , LV and LS . The onset of motor block in group LVS (18 9 minutes) was also significantly faster compared to other groups. A statistically significant prolongation of duration of analgesia was detected in group LVS as compared with other groups , being 481 119 minutes in group LVS. A significant prolongation of motor block in group LVS wasdetected being 422 66 minutes when compared to groups L, LV and LS . Postoperative verbal pain score was significantly lower at 12 h in group LVS when compared with other groups at the same time . No significant inter-groups or intra-group changes in HR, MAP, SaO2, PaCO2 and pH were detected. Serum cortisol and glucose showed a significant decrease at 2 hours postoperatively in group LVS when compared to other groups. No major cardiovascular, respiratory, or central nervous system complications were observed in the studied groups . From the present study it can be concluded that the use of verapamil - sufentanil combination with lidocaine for continuous BPB improved onset of sensory and motor block provided prolonged postoperative analgesia, and achieved high level of patients’ and surgeons’ acceptability.