الفهرس 
INTRODUCITONOnly 14 pages are availabe for public view
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Abstract
Hand and forearm traumatic injuries are increasingly recognized as a major public health problem. The danger of such traumatic injuries as a clinical entity is for two reasons: first because they are very common to be encountered during practice (5-10% of emergency department visits). Second because they impose a significant economic burden on the community with a high percentage of patients unable to return to work.
Regional anesthesia is increasingly taking place in patients with upper limb injuries. It is logical choice as it avoids the effects of muscle relaxants, narcotics and potent volatile anaesthetics used in general anesthesia.
Brachial plexus block is a popular and widely employed regional nerve block technique for perioperative anesthesia and analgesia for surgery of the upper extremity and infraclavicular approach represents a reliable and safe approach for surgery below the shoulder joint.
Ultrasound guidance improves the quality of brachial plexus block. The ability to image the plexus, pleura and axillary artery and vein with ultrasound guidance has increases safety and decreases the risk of complications.
Different additives have been used as adjuvant with local anaesthetics to achieve dense and prolonged block. Dexmedetomidine has a potent analgesic, sedative and anxiolytic effect through inhibition of the firing of nociceptive neurons and inhibition of the release of substance