Comparitive Study between Dexamethasone versus Fentanyl As Adjuvant to Local Anesthesia in Supraclavicular Nerve Block in Upper Limb Surgery

Abstract

eripheral nerve block as an anesthetic technique plays an important role in modern regional anesthesia. Upper limb surgeries are mostly performed under peripheral blocks such as the brachial plexus block. Peripheral nerve blocks not only provide intra-operative anesthesia, but also extend analgesia in the post-operative period without major systemic side-effects by minimizing stress response and using minimal anesthetic drugs. Regional nerve blockade avoids the unwanted effects of anesthetic drugs used during general anesthesia and beneficial for the patients with various cardiorespiratory comorbidities. In supraclavicular approach, the plexus is blocked where it is most compactly arranged at the level of the nerve trunks; as a result, a block with rapid onset can be achieved. Various adjuvants, including opioids, midazolam, magnesium sulfate, dexamethasone, and neostigmine, have been added to local anesthetics in an attempt to increase the duration of block and postoperative analgesia. Ultrasound guidance has many advantages, as it can potentially improve the success rate up to 99%, fastens the onset time and reduce the incidence of complications such as pneumothorax or intravascular injection.