scholarly journals A Comparative Clinical Study of Levobupivacaine and Levobupivacaine with Dexmedetomidine for Supraclavicular Brachial Plexus Block

2021 ◽  
Vol 8 (13) ◽  
pp. 760-763
Author(s):  
Sabir Hasnat ◽  
Sohail Ahmad ◽  
Ashutosh Kumar Jha
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Duration Of Action ◽  
Upper Limb Surgery ◽  
Prolonged Duration ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

BACKGROUND Sensory and motor functions of peripheral nerve can be blocked by injecting local anaesthetic around the group of nerves, which will stop the conduction of nerve impulse. Peripheral nerve block is a well-accepted technique in anaesthesia care. Brachial plexus block is also one of the reliable techniques in providing regional anaesthesia for upper limb surgery. METHODS This was a prospective, double blinded, randomised comparative study which included 40 patients of American Society of Anaesthesiologists (ASA) grade I and II of either sex of 20 - 65 years old age groups for upper limb surgery. Cases were divided randomly into two groups: Group A: received levobupivacaine hydrochloride 0.5 % 25 cc with dexmedetomidine injection. Group B: received levobupivacaine hydrochloride 0.5 % 25 cc injection. Each individual was allocated to respective group by computer generated randomisation chart. Both group A and B were assessed for the onset of sensory & motor block, duration of postoperative analgesia and duration of action. RESULTS In the present study, it was observed that the onset of sensory blockade (P < 0.001) & motor blockade (P < 0.001) was earlier in groups A with prolonged duration of sensory & motor blockade (P < 0.001) as compared to group B. Group A took longer time for first rescue analgesia post operatively compared to group B, and the difference was found significant (P < 0.001). Both group A and group B were comparable for systolic blood pressure, diastolic blood pressure, and heart rate. CONCLUSIONS The onset of sensory and motor blockade was early in 0.5 % levobupivacaine with dexmedetomidine with prolonged duration of action and required lesser dose of rescue analgesic in 0.5 % levobupivacaine with dexmedetomidine as compared to 0.5 % levobupivacaine in supraclavicular brachial plexus block. KEYWORDS Dexmedetomidine, Levobupivacaine, Brachial Plexus Block

scholarly journals Effect of Addition of Dexamethasone to Local Anaesthetics in Supraclavicular Brachial Plexus Block

1970 ◽  
Vol 7 (1) ◽  
pp. 11-14 ◽  
Author(s):  
SM Islam ◽  
MHMD Hossain ◽  
AA Maruf
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Local Anaesthetics ◽  
Prolonged Duration ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

Introduction: Many-a-time local anaesthesia appears as a very effective alternative of general one. Different additives have been used to prolong regional blockade. Objective: This prospective study designed to evaluate the effect of dexamethasone added to local anaesthetics on the onset and duration of supraclavicular brachial plexus block. Methods: Sixty adult patients undergoing various orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial plexus block were selected and divided into 2 groups of 30 each. In group-A patients received 35 ml of mixture of lignocaine 2%, bupivacaine 0.5% while in group-B patients received the same amount of local anaesthetics with dexamethasone (8 mg). The onset of sensory and motor block and duration of analgesia in two groups were compared and development of complications were observed. Result: The two groups were comparable in demographic data. The mean onset time of sensory block was 11.64±2.19 minutes in group A and 9.89±1.97 minutes in group B and difference was statistically significant (p<0.05). Onset of motor block was 13.32±0.98 minutes in group A and 11.09±1.28 minutes in group B and difference was statistically significant (p<0.05). There was markedly prolonged duration of analgesia in group-B, 11.87± 0.53 hours compared to group-A, 3.43±0.49 hours. The result was statistically highly significant (p<0.001). Both the groups had high success rate (>90%). The incidence of complication was low in both the groups. Conclusion: Addition of dexamethasone as an adjuvant to local anaesthetics in brachial plexus block results in significantly early onset and markedly prolonged duration of analgesia without any unwanted effects. Key words: Supraclavicular block; analgesia; local anaesthetics; dexamethasone DOI: http://dx.doi.org/10.3329/jafmc.v7i1.8619 JAFMC Bangladesh. Vol 7, No 1 (June) 2011; 11-14

scholarly journals Addition of clonidine or fentanyl with bupivacaine for supraclavicular brachial plexus blocks in upper limb surgery - a randomized comparative study

2014 ◽  
Vol 24 (1) ◽  
pp. 3-7
Author(s):  
Nasir Uddin Ahmed ◽  
Mozaffor Hossain ◽  
AKM Akhtaruzzaman ◽  
Montosh Kumar Mondol ◽  
UH Shahera Khatun
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Control Group ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Plexus Block

Background The popularity of supraclavicular brachial plexus block in upper limb surgery in recent years are due to better understanding of using adjuvant to local anaesthetics, its advantages and in avoidance of the hazards of general anaesthesia. Objective To compare the quality of anaesthesia and duration of analgesia with clonidine-bupivacaine or fentanyl-bupivacaine in supraclavicular brachial plexus block. Method A total number of 60 patients (ASA class 1 and II) were selected randomly into two groups, thirty in each group. Group-A (control group) received fentanyl (100ìg) 2ml and bupivacaine (0.25%) 38ml, total of 40ml.Group-B (study group) received clonidine (150ìg) 2ml and bupivacaine (0.25%) 38ml, total of 40ml.The parameters including pulse rate, non-invasive systolic and diastolic blood pressure, respiratory rate, SpO2, onset and duration of motor and sensory block, post operative pain score in VAS, duration of analgesia, first analgesic demand, side effects were assessed and recorded. Result Onset and duration of sensory block were significantly higher in group-B than in group-A (P<0.001) and motor block were quite prolonged in group-B than group-A (p<0.001), prevalence of sedation in group-B slightly higher than group-A. But intensity of pain measured by VAS in group-A expressed highest at 8 hours of postoperative period and group-B shows highest VAS at 12 hours. Duration of effective analgesia (time from supraclavicular block to first analgesic demand) in study group-B had significantly longer mean duration than that produced by control group-A (14.4 ± 1.3 vs 10.9 ± 1.5 hours; P<0.001). Conclusion Clonidine and bupivacaine combination is a better alternative to fentanyl and bupivacaine in respect of quality of anaesthesia and duration of analgesia. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19792 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 3-7

scholarly journals A comparative study between the effect of verapamil versus nalbuphine as an adjuvant in supraclavicular brachial plexus block

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mohammed Ibrahim Khamis ◽  
Ahmed Saeed Mohamed ◽  
Hesham Mohamed El Azazy ◽  
Hala Salah El Ozairy ◽  
Mohamed Moien Mohamed
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Normal Saline ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Motor Blockade ◽  
Group A ◽  
Group B ◽  
Plexus Block

Abstract Background Brachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline. Results Results of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block. Conclusion Both drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

Dexamethasone as an Adjuvant to 0.5 % Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block

2021 ◽  
Vol 8 (14) ◽  
pp. 849-853
Author(s):  
Shweta Saurin Mehta ◽  
Nidhiben Sureshbhai Patel
Keyword(s):  
Adverse Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Supraclavicular Approach ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Regional Anaesthetic Technique ◽  
Plexus Block

BACKGROUND Supraclavicular brachial plexus block is a reliable, regional anaesthetic technique for upper limb surgeries. Also known as “spinal of upper limb”.1 The present study was conducted to assess the analgesic efficacy of dexamethasone as an adjuvant to 0.5 % ropivacaine for ultrasound sonography (USG) guided brachial plexus block. METHODS 50 adult patients of American Society of Anaesthesiologists (ASA) physical status I and II of both genders, aged 18 - 50 years scheduled for elective upper limb surgeries under brachial plexus block via supraclavicular approach were randomised into 2 groups of 25 patients each to receive either 20 ml of 0.5 % ropivacaine with 2 ml of normal saline (group A) or 20 ml of 0.5 % ropivacaine with 2 ml of dexamethasone (8 mg) (group B). RESULTS Use of ultrasound helps in better visualisation of nerves, needle & spread of local anaesthetic at brachial plexus block site. So, less amount of drug volume is required for the block. Time of onset of sensory and motor block was significantly lower in group B compared to group A. Mean duration of motor and sensory block was significantly longer in group B than group A. The duration of postoperative analgesia was 18.79 ± 2.31 hours in group B & 9.06 ± 0.35 hours in group A, with statistically highly significant difference (P < 0.05). There were no perioperative haemodynamic variations between the two groups and no complication of technique or adverse effects due to dexamethasone occurred. CONCLUSIONS Dexamethasone 8 mg has significantly extended duration of analgesia of brachial plexus block with no adverse effects. KEYWORDS Brachial Plexus Block, Ropivacaine, Dexamethasone, Supraclavicular Approach, Ultrasound Guidance

A CLINICAL COMPARISON BETWEEN 0.5% BUPIVACAINE AND 0.5% BUPIVACAINE DEXAMETHASONE 8mg COMBINATION IN BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

2021 ◽  
pp. 18-20
Author(s):  
Bonthu Mounica ◽  
Palle Krishna Padma Sri ◽  
K. Madhusudhan Reddy
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Single Shot ◽  
Motor Blockade ◽  
Duration Of Action ◽  
Group I ◽  
Prolonged Duration ◽  
Group Ii ◽  
Plexus Block

Aim:To study the onset and duration of sensory and motor blockade Introduction: Brachial plexus block provides a useful alternative to general anaesthesia for upper limb surgeries. Bupivacaine is one of the most frequently used local anaesthetic which has a longer duration of action of 3 to 8 hours but has drawbacks of delayed onset and patchy analgesia. Dexamethasone is a very potent glucocorticoid with very good anti-inammatory and analgesic activity. Materials and methods: A prospective, randomised single-blinded study was undertaken in patients posted for upper limb surgeries under the supraclavicular block. 60 patients with ASA class I and II were randomly grouped into two groups. Group I received 30ml bupivacaine 0.5% and Group II received a combination of 28ml bupivacaine 0.5% and 2ml dexamethasone 8mg. 30ml solution is used for a single shot blockade of supraclavicular brachial plexus. Results: Group II patients had a faster onset of action and prolonged duration of action. Discussion: The addition of dexamethasone 8mg to bupivacaine 0.5% speeds the onset of sensory and motor blockade also prolongs the duration thus provides better analgesia and reduces the requirements of rescue analgesics. Conclusion:Acombination of bupivacaine 0.5% and dexamethasone 8mg has a signicantly faster onset and prolonged duration of action.

scholarly journals A comparison of ultrasound versus paresthesia technique for supraclavicular brachial plexus block

2017 ◽  
Vol 4 (1) ◽  
pp. 198
Author(s):  
Bidyut Borah ◽  
Smita R. Engineer ◽  
Kiran B. Patel
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Ultrasound Guided ◽  
Ultrasound Technique ◽  
Sensory Blockade ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Patient Groups ◽  
Plexus Block

Background: Ultrasonography is a newer tool for identification of nerves in the practice of regional anaesthesia. Visualization of target structures and spread of drugs under direct vision and thus avoiding complications like pneumothorax, accidental intravascular injections are potential benefit of ultrasonography technique. Aim of the study was to examine the usefulness of ultrasound guided brachial plexus block and compare it with paresthesia technique with the believe that ultrasound guidance can shorten the onset as well as increase the duration of blockade..Methods: Eighty patients of either sex, 18-60 years, posted for upper limb surgery were divided into 2 groups according to the technique used to give block, group US (ultrasound technique) and group PA (paresthesia technique).  Both the groups received 0.5 % bupivacaine 20 ml with 8 mg of dexamethasone.Results: There was notable difference between the patient groups with regard to initiation of motor blockade (10 min group US vs 11.1 min group PA, p <0.0156) and sensory blockade (5.16 min group US vs 6.96 min group PA, p <0.0001) also duration of motor blockade (1272.88 min in group US vs 899.25 min in group PA, p <0.0001) and sensory blockade (1343.88 min in group US vs 996.75 min in group PA, p<0.0001).Conclusions: Ultrasound guided supraclavicular brachial plexus blocks result in a higher success rate with respect to onset and duration of blockade with less incidence of complications compared to paresthesia technique.

scholarly journals A CLINICAL COMPARISON OF 0.75% ISOBARIC ROPIVACAINE WITH 0.5% ISOBARIC BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

2020 ◽  
pp. 43-46
Author(s):  
Kalyan Sarma ◽  
Bandana Mahanta ◽  
Prabir Pranjal Das
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Motor Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
The Mean ◽  
Group B ◽  
Plexus Block

Background: Regional anaesthesia and analgesia, has the potential to provide excellent operating conditions along with better and prolonged post-operative with pain relief with fewer side effects. As a result, it is becoming increasingly popular for ambulatory anaesthesia and for day care patients.. Among the commonly used local anaesthetics, lignocaine and bupivacaine, bupivacaine has significant cardiovascular and central nervous system toxicity. In addition, bupivacaine also has lesser differentiation between sensory and motor blockade post-operatively. Ropivacaine and levobupivacaine were developed to avoid the bupivacaine related toxicities. The clinical safety profile of ropivacaine seems to be more favourable than that of levobupivacaine. With this background the following study was conducted to evaluate the efficacy of ropivacaine 0.75% for brachial plexus block in upper limb surgeries and its clinical comparison with bupivacaine 0.5%. Aims and Objectives: To assess the efficacy and toxicity of ropivacaine 0.75% and bupivacaine 0.5% as potential agents for brachial plexus block for surgeries of the upper limb around and below the elbow. Settings and Design: prospective, comparative, randomized, single blinded clinical trial. Materials and Methods: After institutional ethical committee approval, 100 patients physical status ASA I & II, of either sex, between 18-60 years, weighing between 40-60 kgs posted for upper limb surgeries around the elbow, forearm and hand were divide into two groups of 50 patients each. Group R (Ropivacaine group) received 0.75% isobaric ropivacaine 30 ml in supraclavicular brachial plexus block. Group B (Bupivacaine group) received 0.5% isobaric bupivacaine 30 ml in supraclavicular brachial plexus block by using peripheral nerve stimulator. Vitals, sensory, motor and analgesia score at pre-defined intervals intra-operatively were noted. Onset of analgesia, sensory & motor blockade, total duration of post-operative pain relief (VAS ≥ 5) and time of demand of first rescue analgesic were also noted along with any intra-operative complications, if any. Statistical Analysis: All the results were expressed as Mean ± SD. Statistical analysis was performed using Unpaired Student’s t-Test. Statistical significance was considered with a p value of ≤ 0.05. Results: Demographic profile and duration of surgery were comparable among the two groups. The mean time of onset of sensory block, onset of motor block and onset of analgesia were significant (p<0.05) in group R as compared to group B. The mean duration of sensory block and duration of post-operative analgesia were comparable between the two groups. However, the mean duration of motor block was significantly lower (p<0.05) in group R as compared to group B. the baseline hemodynamic variables and requirement of first analgesic dose and other adverse events were equivalent in both the group. Conclusion: Ropivacaine when compared with Bupivacaine, has faster onset of analgesia, sensory & motor blockade, significantly lesser duration of motor blockade. Ropivacaine also provides satisfactory post-operative analgesia with a stable hemodynamic profile similar to Bupivacaine with no undue adverse effects.

scholarly journals Bupivacaine-dexmedetomidine versus bupivacaine-nalbuphine in ultrasound-guided supraclavicular brachial plexus block: a prospective, randomized, double-blind study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
H. S. Mohamed ◽  
G. S. Gad
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Isotonic Saline ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Double Blind ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Post Operative Nausea ◽  
Plexus Block

Abstract Background Brachial plexus block is frequently performed for ambulatory upper limb surgery as an alternative to general anesthesia. It can significantly reduce pain, reduce post-operative nausea, and vomiting and allowing for faster discharge from hospital. Performing this block under ultrasound guidance has higher index of safety and can monitor the distribution of local anesthetic (LA) in real time. The aim of this study is to compare the block characteristics among bupivacaine-dexmedetomidine (BD), bupivacaine–nalbuphine8 (BN), and bupivacaine-isotonic saline groups. Results The duration of both the sensory and motor blockade was statistically longer in both BD and BN groups with a longer duration of analgesia compared to the BS group. Also, the BD group showed statistically significant higher sedation scores at different times during the study compared with both the BN and BS groups. Conclusion Adding either dexmedetomidine or nalbuphine to isobaric bupivacaine in US-guided supraclavicular brachial plexus block prolongs both sensory and motor blockade. Dexmedetomidine produces significant sedation when added to bupivacaine.

scholarly journals Anaesthetic and analgesic eects of adding fentanyl to bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block – a comparative study with or without fentanyl

2016 ◽  
Vol 44 (1) ◽  
pp. 26-31
Author(s):  
Farhanaz Zainab ◽  
Mohammad Omar Faruq ◽  
Moumita Talukder ◽  
Sabina Yeasmeen ◽  
AKM Shamsul Alam ◽  
...  
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Plexus Block

Brachial plexus block is gaining popularity day by day for upper extremity surgery because it has manifold advantages. Supraclavicular approach offers a high success rate for elbow, forearm, hand surgery. Different mixtures of local anesthetics are intended to provide faster block onset than long-acting agents and to extend the duration typically seen with intermediate or short-acting agents. This prospective, randomized comparative study was conducted to compare the onset time of sensory block, onset time of motor block and time to achieve complete block, duration of analgesia adding fentanyl with bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block. A total of 60 patients fulfilling the inclusion and exclusion criteria were selected for the study & devided into two groups. Group A received lignocaine-bupivacaine mixtures( 1% lignocaine, 0.25% bupivacaine) and was considered control; group Group B received fentanyl (100?g) with the local anaesthetic mixtures( 1% lignocaine, 0.25% bupivacaine). The mean onset of sensory and motor block were significantly early in group B compared with that of group A. The mean time to achieve complete block and duration of analgesia were significantly longer in group B. It was revealed in the study that patients of group B had no pain up to 4 hrs, there was first reporting of pain (VAS >4) around 5 hrs, the worst pain was experienced after 8 hrs, first dose of analgesic was administered according to patient’s request. The patients of group A had no pain up to 3 hrs. Thereafter pain intensity increased at 4 hrs, around 6 hrs postoperatively the patients experienced the worst pain . This feature reveals a significantly longer duration of analgesia in group B. This study revealed that addition of fentanyl significantly causes early onset of anaesthesia and longer duration of analgesia without any side effects.Bangladesh Med J. 2015 Jan; 44 (1): 26-31

A comparative study between Bupivacaine volumes on diaphragmatic mobility in Ultrasound guided Supraclavicular Block

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Israa Tarek Mohamed Abdelaziz ◽  
Ahmed Nagah El shaer ◽  
Tamer Yousef Elie ◽  
Wael Abd Elaziz Mohamed
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Intravascular Injection ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Group A ◽  
Group B ◽  
Supraclavicular Block ◽  
Plexus Block

Abstract Background Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches. Objective To compare the effect of two different volumes of bupivacaine (20 ml and 25 ml) on diaphragmatic mobility within 15 and 30 minutes from ultrasound guided supraclavicular brachial plexus block in upper limb orthopedic surgeries. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. Group A received 20 ml of bupivacaine (0.5%) and group B in which patients received 25 ml of bupivacaibe (0.5%). Diaphragmatic excursion measured in both groups after 15 and 30 mins sequentially. Results Our study showed that the use of low volume of bupivacine has much lower incidence of phrenic nerve affection, and in turn affection of mobility of the diaphragm measured by diaphragmatic excursion. Conclusion Assessment of diaphragmatic excursion is the best indication of phernic nerve injury after supraclavicular block. The use of the ultrasonography is the fastes, easiest and safest method for this assessment. The use of ultrasonography in performing the supraclavicular nerve block decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

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