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Introduction: Magnesium sulphate can prolong the effect of local anaesthetics. Adenosine has not been compared to other local anaesthetics adjuvants. In the present study we aimed to compare the effect of adding magnesium sulphate and adenosine to bupivacaine for pectoral nerves block. Patients and Methods: In this randomized controlled trial, 90 females scheduled for breast surgery were included. Patients were divided into three groups. Patients received general anaesthesia with pectoral nerves block. Group C, A, and M had bupivacaine only, bupivacaine + adenosine, and bupivaciane + magnesium sulphate respectively. Post-operative visual analogue score, block duration, post-operative morphine consumption, sedation score, and peri-operative haemodynamic changes were recorded. Results: Visual analog score was lower in Group M compared to other groups. Group A and M showed significant longer duration of the block. Group M showed significant longer duration of action than Group A (p = 0.034). The total peri-operative morphine used was higher in Group C (p < 0.05). Post-operative Ramsay sedation score was significantly lower in Group A during the first two hours post-operatively (p > 0.05). Conclusions: Local anaesthetic adjuvants such as adenosine or magnesium sulphate can improve pectoral nerves block characteristics. Magnesium sulphate has an advantage over adenosine by increasing the block duration.

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Background:Psoas sciatic block (Pso/Sci) is a modern anesthetic technique for lower extremities surgery. The use of this technique can avoid the adverse effects of the general anesthesia or the central neuroaxial blockade, especially in patients with multiple comorbidities.Purpose:The purpose of this study is to compare the efficacy of combined Pso/sci as a sole anesthetic technique with conventional combined spinal epidural (CSE) anesthesia for patients undergoing total knee arthroplasty.Methods:Eighty patients scheduled for total knee replacement were included in the study. Patients were divided into two equal groups: Pso/sci group received ultrasound guided with the use of nerve locator continuous Pso/sci and the second group (CSE) received CSE anesthesia. Onset of sensory and motor block time, hemodynamic changes, contralateral spread, first-time need for analgesia, incidence of complications, and patient and surgeon satisfactions were recorded.Results:The block time was significantly higher in the (Pso/Sci) group. Two patients in (Pso/Sci) had contralateral spread. Sensory and motor block onsets were delayed significantly in (Pso/Sci). Hemodynamic changes occurred in the CSE; however, it was insignificant compared to Pso/sci group. The first analgesic request was significantly later in (Pso/Sci) compared to the CSE group. There were no differences found in both groups as regard complications, early mobilization, and patients and surgeons satisfaction.Conclusions:Psoas sciatic block is an alternative safe and successful anesthetic technique, which can provide an adequate anesthesia for total knee surgery with less hemodynamic changes.