We present a case of unexpectedly prolonged motor and sensory block following a successful single injection ultrasound – guided infraclavicular block with bupivacaine (0.25%) and dexamethasone (8 mg). ultrasound guidance and safety measurement such as injection of the local anaesthetic at a slow rate and verifying that usual resistance was felt throughout the injection, has been applied. It took 42 hours for the block to go away. Although there was no evidence of neurologic injury but we should always be prepared to consider the possibility of nerve injury and take appropriate measures.

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Background: Emerging from general anesthesia remains a passive process. Recent studies show the importance of dopaminergic pathways in sleep–wake cycles. The effect of caffeine in increasing the level of consciousness and cognitive function has been well documented. The purpose of the current study was to evaluate the effect of intravenous caffeine, a dopamine receptor stimulant, on accelerating recovery from Total Intravenous Anesthesia (TIVA) with propofol.  Methods: Fifty patients, aged between 20 to 50 years old scheduled for elective laparoscopic cholecystectomy, were enrolled in this double-blind clinical trial, and forty-eight were analyzed.  The study group, consisting of 24 patients, received 500 mg IV caffeine infusion 15 minutes before the end of the surgery. The control group, comprising 24 patients, received an equal volume of saline infusion.  Emergence profile was evaluated and compared in two groups. The depth of anesthesia was determined by Bispectral Index (BIS) monitoring. Results: Our research demonstrated that in the study group, the time intervals for increasing BIS values from 60 to 80, endotracheal extubation, eye-opening on verbal command, and achieving an Aldrete’s discharge score ≥ 8 were significantly less than the control group.  Short Orientation Memory Concentration Score (SOMCT) was lower in the control group as well. Incidence of nausea, vomiting and, shivering had no significant difference between the two groups. Conclusion: Since emergence from general anesthesia is a passive process, caffeine may be used as a measure for active reverse of general anesthesia at clinical practice.