A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided supraclavicular brachial plexus block in upper limb surgeries

Abstract

Brachial plexus blocks are among the most commonly performed peripheral nerve blocks for upper extremity surgeries in clinical practice. It offers many advantages over general anaesthesia for upper limb surgeries such as sympathetic block, better postoperative analgesia, high success rate and fewer side effects. Brachial plexus is a complex network of nerves supplying the upper limb, with both sensory and motor supply. It is formed by the convergence of the ventral rami of the spinal nerve roots from C5 to T1. It is composed of 5 roots, 3 trunks (upper, middle and lower), 6 divisions, 3 cords (lateral, medial and posterior) and terminal branches. Among the different approaches to the brachial plexus, the supraclavicular approach is the easiest and most consistent method for anaesthesia and perioperative pain management in surgery below the shoulder joint. The application of the ultrasound in supraclavicular brachial plexus block is of great significance. It has decreased the incidence of complications (such as pneumothorax and intravascular injection) and so improved the patient safety. It also improved the success rate of the block by visualization of the brachial plexus and detecting anatomical variations