الفهرس 
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Abstract
This study was carried out after approval of ethical committee ,and written informed consent from 60 patients aged 18-65 years with ASA 1-11 who were candidate for distal upper limb surgeries by axillary block are enrolled in the study , in sohag university hospital .
The aim of our study was to compare onset , duration and analgesic efficacy of ultrasound guided axillary block when dexamethasone or ketorolac added to local anaethetic for anesthesia in distal upper limb surgeries .
The patients will be randomly allocated to three groups 20 patients each as : Dexamethasone (D) , ketorolac (K), control (C) groups) .)
- Dexamethasone (group D):
patient will receive 30 ml of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml .
- ketorolac (group K):
patient will receive 30 ml of 0.375 bupivacaine plus 2 ml ketorolac .
- control (group C) :
patient will receive 30 ml of 0.375 bupivacaine and normal saline 2ml .
After institution of the blockade , the onset time of sensory and motor block was recorded. The surgery was allowed to proceed and when complete anesthesia was achieved and Patients were primedicated with 1mg midazolam intravenously in the operating room before surgery started. Intra operatively HR, NIBP, SPO2 were monitored every 5 minute.
Post operatively, the following parameters were assisted: duration of sensory and motor block, VAS score were assessed at 4, 8, 16, 18, 19, 20, 21, 22, 23, 24hr,the first request for analgesics.
The result of our study demonstrated that addition of dexamethasone to bupivacaine resulted in significant reduction in onset time of sensory and motor blocks, prolonged duration of post operative analgesia, lower analgesic consumption and lower incidence of adverse effects.
The use of ultrasound helped us in good localization of brachial plexus and prevented occurrence of major complications.
Conclusion
The addition of dexamethasone to bupivacaine resulted in significant reduction in onset time of sensory and motor blocks, prolonged duration of post operative analgesia, lower analgesic consumption and lower incidence of complications.
The use of ultrasound helped us in good localization of brachial plexus and prevented occurrence of major complications.