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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 |