الفهرس 
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Abstract
The study was designed to evaluate the effect of dexamethasone as adjuvant to levobupivacaine in ultrasound-guided interscalene block in shoulder and upper arm surgeries, and which route, the perineural or the intravenous was more effective regarding the analgesic effect, duration of analgesia and hemodynamic stability. Ninety patients with age ranging from (20-60) years of either sex undergoing shoulder and upper arm operations at Mansoura University Hospital were randomly allocated into three equal groups; group L (n=30): patients were received interscalene brachial plexus block with 20 ml of 0.5% levobupivacaineplus2 ml saline with intravenous 10 ml normal saline administration (placebo group). group LDp (n=30):patients were received interscalene brachial plexus block with 20 ml of 0.5% levobupivacaine plus dexamethasone 4mg diluted in 2 ml saline with intravenous 10 ml normal saline administration. group LDiv (n=30): patients were received interscalene brachial plexus block with 20 ml of 0.5% levobupivacaine plus 2 ml saline with administration of intravenous dexamethasone 4mg diluted in 10 ml normal saline. Patients received ultrasound guided interscalene brachial plexus block. Block success was defined as loss of sensation to pinprick in the C4 and C5 sensory dermatome distributions measured 30 min after the end of local anesthetic injection ,and inability to move the shoulder and arm. Data recorded was onset of sensory and motor block, duration of sensory and motor block, intraoperative analgesic consumption and time to first analgesic request .Visual analogue score was measured at 1, 2, 6, 12 and 24 hrs postoperatively. Pain was managed if VAS was or the patient requested analgesia by injection of intravenous pethidine 25 mg. Hemodynamic parameters including mean blood pressure and heart rate were recorded intraoperative and in the PACU. Results of this current study showed that the addition of perineural dexamethasone to levobupivacaine for interscalene nerve block showed earlier onset of sensory and motor block, prolonged duration of sensory and motor block ,prolonged duration of analgesia and decreased the postoperative pain after upper limb surgery than levobupivacaine alone or levobupivacaine with intravenous dexamethasone. This study recommends the use of perineural dexamethasone as adjuvant to a levobupivacaine for interscalene nerve block in shoulder and upper arm surgeries. More studies are needed to determine the optimal dose and to examine the safety profile of dexamethasone before its routine use as perineural adjuvant.