الفهرس 
Anatomy of brachial plexusOnly 14 pages are availabe for public view
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Abstract
Regional anesthesia provides a safe anesthesia for upper extremity surgery, supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. The use of ultrasound guidance for regional anesthesia became popular owing to detection of anatomical variants, painless performance and more accurate needle placement to avoid injury to arteries, veins and pleura so decrease incidence of pneumothorax. It also helps to monitor the spread of local anesthetic solution in the appropriate tissue. Bupivacaine is a long-acting amide local anesthetic agent when used in 0.5% concentration. The effect of 0.5% bupivacaine may persist for 2-3 hours if administered alone. Ketamine is an N-Methyl D-Aspartate antagonist with analgesic properties which modulates central sensitization of nociceptive stimulation. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and to enhance the effect of local anesthetic by its action on gamma aminobutyric acid-A (GABA-A) receptors The aim of this study to compare the effect of midazolam added to bupivacaine versus ketamine added to bupivacaine in ultrasonic guided supraclavicular brachial plexus block for patients undergoing upper limb surgeries.