الفهرس 
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Abstract
Regional block techniques avoid the unwanted effects of the anesthetic drugs used during general anesthesia and hemodynamic stress during laryngoscopy and intubation. Brachial plexus block is one of them, widely employed regional nerve block technique for perioperative anesthesia and analgesia for surgery of the upper extremity. Different drugs have been used as adjuvants with local anesthetics in brachial plexus block to achieve quick, dense and prolonged block Drugs like morphine, pethidine, clonidine, dexmeditomidine, and midazolam are commonly used along with local anesthetics for this purpose. But these drugs are associated with side effects like heavy sedation, respiratory depression and psychomimmetic effects, drugs with minimal side effects are always looked for Ultra low dose of naloxone added as adjuvant to local anesthetic solution in brachial plexus block, prolongs nerve sensory and motor blockades with enhanced opioid effect. After approval by department of anesthesia and surgical ICU and institutional research board –Mansoura University sixty four patients scheduled for orthopedic upper limb surgery at Mansoura university hospital. Patients with history of allergy to the drug of the study, Coagulation disorders and infection at the puncture site, pregnancy, opioid addiction, uncontrolled psychological problems, evident or doubt of nerve injury at this limb and uncooperative patients are excluded. Patients were located in two equal groups each one is 32 patients: •Bupivacaine group: (n=32) Patients received 20 mL bupivacaine 0.5% plus 3 ml of saline (to achieve blindness) under US. •Bupivacaine naloxone group: (n=32)Patients received 20 mL bupivacaine 0.5% plus 100 ng naloxone (1ml) in 2ml saline.(naloxone ampoule 0.4mg diluted in 400ml of saline then 1ml of it diluted in 10 ml saline, so each ml had 100ng naloxone) under US Data regarding the duration of surgery ,sensory and motor block onset time, duration of sensory and motor block,1st analgesic requirement, number of analgesic request, interval between each analgesic request and total analgesic requirement was collected.Haemodynamics including blood pressure, heart rate and blood oxygen saturation was recorded. Pain score (VAS) of early postoperative pain, intra and post-operative sedation score and incidence of side effects were assessed. Our result showed prolongation of the duration of sensory and motor block by the addition of (100 ng) of naloxone to bupivacaine as compared with bupivacaine alone in brachial plexus block. There was significant decrease in total analgesic requirements and number of analgesic requirements in group BN than groupB.the interval between each analgesic requirements was prolonged in group BN than group B. There was not a significant change in values of mean arterial pressure, heart rate and blood oxygen saturation between the two studied groups. Postoperative visual analogue scale for early postoperative pain significantly decreased in BN group compared with B group. There was no significant difference between the two groups in the incidence of side effects and sedation score.