Background the aim of this study is to compare between ketamine and dexamethasone when added to bupivacaine in ultrasound guided infraclavicular brachial plexus block for upper limb surgeries. Methods: The patients were randomly allocated to two groups, 25 patients each: Group K (ketamine group) Patient received 30 ml of 0.375% bupivacaine plus 0.5 mg/kg ketamine in 2 ml saline Group D (dexamethasone group) Patient received 30 ml of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml. Results: Onset time of sensory and motor blocks was significantly decreased in dexamethasone group in comparison with the ketamine group. The visual analogue scale was significantly lower in patients who received dexamethasone versus patients who received local anesthetics and ketamine. The duration of analgesia and resolution of motor block were significantly prolonged in dexamethasone group as compared to ketamine group. Postoperative analgesic consumption was reduced significantly in dexamethasone group as compared with ketamine group. 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 aim of this review was to compare Supraclavicular Brachial Plexus Block by Ketamine-Bupivacaine versus Bupivacaine with Intravenous Ketamine Infusion Methods: A comprehensive search was conducted in search engines from August 2000 to July 2021, using the keywords . The reviewers evaluated relevant literature references as well. Only the most recent or complete study was taken into account. Results: The reviewed literature showed that VAS was significantly lower at 12 h in group 1 but insignificantly different at 1/2, 1, 1.5, 2, 3, 4, 6 and 24 h between both groups; so do postoperative heart rate and mean arterial pressure. Onset of sensory block and onset of motor block was significantly lower in group 1. Duration of sensory block and duration of motor block was significantly higher in group1. Both time of 1st rescue analgesia was significantly delayed in group 1 and total ketorolac requirements were significantly lower in group 1. Sedation score was significantly different between both groups. On the opposite postoperative respiratory rate and SpO2 were insignificantly different between both groups. Conclusion: Using ketamine bupivacaine in supraclavicular brachial plexus block in upper limb surgeries is effective in enhancing onset of the brachial plexus block and prolonging the duration of the brachial plexus block with no hemodynamic changes, it effectively prolongs postoperative analgesia and lowers the analgesic requirements compared to intravenous ketamine infusion.

Aim:To compare onset , duration and analgesic efficacy of axillary block when dexamethasone or ketorolac added to local anaethetic . . Patient and Methods: 60 patients aged 18-65 years with ASA I-II who were candidate for distal upper limb surgeries by axillary nerve block were enrolled in this randomized controlled double blinded study , in sohag university hospital . .Patients were Randomly allocated to( 3) groups (20) patients each ( using sealed envelope technique ) as : -Dexamethasone (group D): patient received 30 ml of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml . -ketorolac (group K):patient received 30 ml of 0.375 bupivacaine plus 30mg ketorolac in 2ml.-control (group C) : patient received 30 ml of 0.375 bupivacaine and normal saline 2ml).Immediately after administration; the patients were turned into the supine position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block; In the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS). Complications also were observed .Results: Dexamethasone had a faster Onset of sensory block onset than Magnesium Sulphate; Dexamethasone had a longer duration of regard Duration of motor block than Magnesium Sulphate; Magnesium Sulphate group had a longer analgesic effect stayed longer than Dexamethasone group .No Significant difference Between Two groups in rate of Complications ; Hypotension and Bradycardia were the most frequent complications in the two groups .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 PDF created with pdfFactory Pro trial version www.pdffactory.com SOHAG MEDICAL JOURNAL Dexamethasone and Ketorolac as an adjuvant to Bupivacne