الفهرس 
Anatomy of the Brachial PlexusOnly 14 pages are availabe for public view
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Abstract
Introduction: Supraclavicular approach is the easiest and most consistent method for surgery below the shoulder joint. The compactness of the brachial plexus in this location facilitates a rapid onset and complete block of the brachial plexus for procedures distal to the shoulder. Regional nerve block minimizes the stress response to surgery and allows using minimal anesthetic drugs which is always beneficial for the patients with various cardio-respiratory co-morbidities,There have been clinical studies evaluating the effect of mixing dexmedetomidine with local anesthetics during peripheral nerve blockade. Peripheral analgesic effects of dexmedetomidine have enabled an overall improved blockade quality when added to local anesthetics in a peripheral nerve block model which is thought to be mediated by α2 receptor binding. Dexmedetomidine also causes local vasoconstriction resulting in delay of absorption of local anesthetics
Patient and method: The study was done as a randomized prospective controlled study, in which the 60 patients were divided randomly into 3 groups (20 patients each) , control group and dexmedetomidine group and fentanyl group with non significant demographic and ASA status
Result: in our study , It was obvious that addition of dexmedetomidine to bupivacaine in supraclavicular bracil plexus nerve block, shortens the onset times of sensory block and motor block and significantly prolongs their duration, and decreases the amount of total post-operative analgesic requirements in comparison to the other two groups, also dexmedetomidine got an added effect of conscious sedation with minimal side effect, make it more superior than fentanyl in the previously used doses.
Conclusion: To conclude, in our study , It was obvious that addition of a 100 micro gram of dexmedetomidine to bupi-vacaine in supraclavicular nerve block, shortens the onset times of sensory block and motor block and significantly prolongs their duration, and decreases the amount of total post-operative analgesic requirements in comparison to 75 micro-gram of fentanyl when added to the same volume and concentration of bupivacaine, that fasten the onset of sensory and motor block ,and also prolongs the duration of the sensory and motor block in comparison to (bupivacaine only), but lesser than (dex-medtomidine group), also dexmedetomidine got and added effect of conscious sedation with minimal side effect, make it more superior than fentanyl in the previously used doses, although further studies with larger sample size are warranted to validate these findings. Also, the usage of ultrasound in performing the supraclavicular nerve block, greatly decreases the incidence of compication such as pneumothorax or intraarterial injection and hence lowers the incidence of systemic toxicity of local anesthetics.