الفهرس 
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Abstract
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.
It has been suggested that supracalvicular block is the most effective technique for blocking the brachial plexus With lower incidence of ipsilateral phrenic nerve paralysis than interscalene block, presumably due to retrograde spread of local anesthetic within the brachial plexus sheath.
Ultrasound guided supraclavicular brachial plexus block allows better visualization of underlying structures, movement of needle and direct spread of local anesthetic and thereby making procedure safe and effective as compared to nerve stimulator guided technique.
Bupivacaine has been one of the most commonly used local anesthetics (LAs) in regional and infiltration anesthesia. It is a long-acting agent capable of producing prolonged anesthesia and analgesia that can be prolonged even further by the addition of many agents.
Diaphragm is the main respiratory muscle with its primary innervation from the phernic nerve. There are several methods to examine the function of the diaphragm. Recently, ultrasound measurement of diaphragmatic excursion has been identified as the easiest, fastest and safest way to assess diaphragmatic function.
The aim of our work is to compare the effect of two different volumes of bupivacaine on diaphragmatic mobility within 15 and 30 minutes from ultrasound guided supraclavicular brachial plexus block in upper limb orthopedic surgeries.
In our study, 40 patients were randomly divided into 2 equal groups. group A received 20 ml of bupivacaine (0.5%) and group B in which patients received 25 ml of bupivacaibe (0.5%). Diaphragmatic excursion measured in both groups after 15 and 30 mins sequentially.
Our study showed that the use of low volume of bupivacine has much lower incidence of phrenic nerve affection, and in turn affection of mobility of the diaphragm measured by diaphragmatic excursion.
The vital data of the patient may not be changed unless both sides of diaphragm have been affected at the same time. So, the lower the volume of bupivacaine used in supraclavicular block, the less the side effects the patient experiences postoperatively.