الفهرس 
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Abstract
Ultrasound has become the cornerstone of peripheral nerve blocks in upper-limb surgeries. The supraclavicular approach provides the easiest and most consistent method of anesthesia for below-shoulder joint surgeries compared to axillary and infraclavicular approaches. There were adjuvants to local anesthetics for brachial plexus block which enhance the quality and duration of analgesia. For example, when dexmedetomidine was administered intraoperatively, it has been reported that pain was reduced during the postoperative period in regional anesthesia. Also, Midazolam which produces an antinociceptive effect and enhances the effect of local anesthetic when it is given epidurally or intrathecally. The aim of this study was to determine the effect of dexmedetomidine or midazolam as a local anesthetic adjuvant to bupivacaine 0.25% on the sensory and motor aspects of the supraclavicular brachial plexus block and the duration of post-operative analgesia in patients having upper limb vascular surgery. The current study included a total of 90 patients scheduled for upper extremity vascular surgery who were recruited from the cardiothoracic and Vascular Surgery Centre at Mansoura University Hospitals. The cases were randomly divided into two groups each of 45 patients. D group included patients who received ultrasound-guided supraclavicular regional block with an injection of bupivacaine, lidocaine hydrochloride and dexmedetomidine. M group included 45 patients who received ultrasound-guided supraclavicular regional block with an injection of bupivacaine, lidocaine hydrochloride, and midazolam. Sensory and motor block, heart rate, non-invasive blood pressure, SpO2, and sedation score (RSS 1-6) were assessed at 1, 2, 4, and 6 hours following the operation. The pain was assessed using the visual analog scale (VAS), which ranges from 0 to 10. Regarding post-operative analgesia there was statistically significant increase in dexmedetomidine compared to midazolam.