الفهرس 
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Abstract
Successful supraclavicular nerve block relies on proper techniques of nerve localization, needle placement, concentration and volume of local anaesthetic used. One of the most important benefits of real-time ultrasound imaging during peripheral nerve blockade is allowing the operator to distribute LA uniformly around the target nerve. This may reduce the amount of LA required to successfully block the nerves so reduce the risk of systemic LA toxicity and other complications.
Increasing the duration of local anaesthetic action is often desirable because it prolongs surgical anaesthesia and analgesia. Steroids have powerful anti-inflammatory as well as analgesic property. Perineural injection of steroids is reported to influence post operative analgesia.
This study evaluated the efficacy of dexamethasone as an adjuvant to low volumes of local anaesthetics in supraclavicular brachial plexus block. We made a comparison between three groups of patients, each group consists of thirty patients scheduled for forearm and hand orthopedic surgeries and anaesthetized by ultrasound-guided supraclavicular nerve block, group A was anaesthetized by injection of 15 ml of bupivacaine 0.5% mixed with 8 mg (2 ml) dexamethasone, group B by injection of 20 ml of bupivacaine 0.5% mixed with 8 mg (2 ml) dexamethasone and group C by injection of 20 ml of bupivacaine 0.5% mixed with 2 ml normal saline.
Ultrasound-guided supraclavicular nerve block was done using linear ultrasound probe by in-plane technique to visualize the brachial plexus.
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All groups were assessed for efficacy of the block by assessing sensory and motor block onset and duration and the quality and duration of postoperative analgesia.
All groups were observed and assessed for incidence of adverse effects (pneumothorax, Horner’s syndrome, hematoma, vascular injury, hoarseness, seizures, systemic toxicity and central neuroaxial blockade).
Statistical comparison of continuous variables was analyzed using one-way analysis of variance and Student’s t-test. Non-continuous variables were analyzed using Fisher exact tests. Statistical significance was assumed at P < 0.05
Addition of dexamethasone to low volumes of bupivacaine in supraclavicular block decreased the onset time of sensory and motor block by statistically significant values.
The duration of sensory and motor block was nearly doubled when dexamethasone was added to bupivacaine used in the block; these effects were more prominent in group B with slightly higher volume of bupivacaine.
In the present study, the onset of sensory block occurred in ulnar nerve distribution more rapid than the other nerves followed by radial then median nerve.
No significant changes regarding intraoperative hemodynamic parameters included heart rate and mean arterial blood pressure.
Dexamethasone caused better quality of postoperative analgesia with lower levels of visual analogue scale and more stable hemodynamic parameters, also caused statistically significant longer duration of postoperative analgesia with lower
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analgesic consumption when added to bupivacaine in supraclvicular block and these effects were more prominent in group B with slightly higher volume of bupivacaine.
There was a very low incidence of complications of supraclvicular block with non significant difference in incidence of complications among the three groups.