الفهرس 
PainOnly 14 pages are availabe for public view
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Abstract
Summary
The interscalene brachial plexus block is widely used for pain
control and anesthetic purposes during shoulder arthroscopic
surgeries and surgeries of the upper extremities. It’s often combined
with general anesthesia for optimal patient comfort. Patients
receiving a block for shoulder surgery have reduced postoperative
opioid consumption, early mobilization is easier, and hospital
discharge is quicker. 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. It’s
effect may persist for 2-3 hours if administered alone.Therefore
adjuvant analgesic strategy is an alternative to prolong the
analgesic duration, to decrease the potential risk of side effects of
local anesthetics by reducing the dose of local anesthetics Many
adjuvants have been added in the effort to prolong the duration
of local anesthetics like dexamethasone , adrenaline , clonidine ,
Magnesium sulphate , Dexmedetomidine & others.
Magnesium has been shown to have antinociceptive effects in
human models by blocking the N-methyl-D-aspartate (NMDA)
receptor and associated calcium channels, thus preventing central
sensitization caused by peripheral nociceptive simulation. The
addition of magnesium sulphate to local anesthetics for neuraxial