الفهرس 
Anatomy of the Brachial PlexusOnly 14 pages are availabe for public view
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Abstract
Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain.
Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block.
Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches.
There is a growing importance to the application of the ultrasound in clinical practice of anesthesia and regional nerve block especially in supraclavicular brachial plexus block. The idea of pre-emptively scanning patient’s anatomy for neurovascular variations or abnormalities has been suggested as a means of improving patient safety by preventing block complications such as pneumothorax, hematoma formation, improper block or intravascular injection.
Clinically, Dexamethasone is high-potency, long-acting glucocorticoid with little mineralocorticoid effect that has been extensively used in the perioperative setting. A single preoperative dose of dexamethasone has gained widespread acceptance as an effective preventive treatment of postoperative nausea and vomiting, and because of its anti-inflammatory effect may have a beneficial role in providing postoperative analgesia. It suppresses both inflammation and immune responses
The aim of this study was to study the effect of dexamesthasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the sensory and motor blocks,the duration of analgesia of the block as well as their effects on the postoperative analgesic requirements. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done.
In our study,50 patients were randomly divided into 2 equal groups. perineural group received bupivacaine (0.5%) concomitant with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone were injected systemically. All patients received equal volumes of 20 milliliters.
Our study showed that addition of a 8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of sensory and motor blocks and significantly prolonged their durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone.