title: The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block.
abstract: OBJECTIVE
  The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block.
  
  
  METHODS
  This is a prospective randomized controlled observer-blinded study.
  
  
  METHODS
  This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 μg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 μg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request.
  
  
  METHODS
  The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E.
  
  
  CONCLUSIONS
  In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects.
authors.affiliation: Department of Anesthesia and ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Ghada F
authors.initials: GF
authors.lastname: El-Baradey
authors.affiliation: Department of Anesthesia and ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Nagat S
authors.initials: NS
authors.lastname: Elshmaa
keywords: Brachial plexus block; bupivacaine; dexamethasone; midazolam; supraclavicular block