Tramadol Versus Dexamethasone as Adjuvant to Levobupivacaine Supraclavicular Block
Tramadol Versus Dexamethasone as Adjuvant to Levobupivacaine Supraclavicular Block
The investigator's aim will be to compare the efficacy of perineural tramadol and
 dexamethasone added to levobupivacaine in prolonging postoperative analgesia in patient
 undergoing open reduction and internal fixation for forearm fractures.

 Primary outcome: duration of postoperative analgesia. Secondary outcome: include [The
 anesthesia onset time, total rescue analgesic consumption in the 1st 24-hour and the presence
 of complications and side effects.
Strategies to prolong brachial plexus nerve blocks analgesia beyond the pharmacological
 duration of the local anaesthetic used include placement of indwelling perineural catheters
 to allow prolonged infusion or the co-administration of adjuvants such as epinephrine, alpha
 2 agonists (as clonidine and dexmedetomidine), midazolam, or the corticosteroid dexamethasone
 .

 Dexamethasone improves the quality and duration of peripheral nerve block over local
 anaesthetic alone. This is thought to be mediated by attenuating the release of inflammatory
 mediators, reducing ectopic neuronal discharge, and inhibiting potassium channel-mediated
 discharge of nociceptive C-fibres .

 Tramadol is a unique opioid with two modes of action for inhibition of pain, an opioid action
 mediated by the μ receptor and a non-opioid action mediated by α-2-adrenergic and
 serotoninergic activity .The monoaminergic activity of tramadol inhibits the descending pain
 pathways, resulting in suppression of nociceptive transmission at the spinal level . Tramadol
 also exhibits local anaesthetic properties by blocking K+ channels .Many studies have
 characterized the effects of tramadol as an adjuvant to local anaesthetic in brachial plexus
 block .
Inclusion Criteria:

 -  American Society of Anesthesiologist physical status I-II patients older than 18years
 and scheduled for internal fixation for forearm fractures

 -  Both sexes

 Exclusion Criteria:

 -  Patients with known allergy to the study drugs

 -  Skin infection at site of needle puncture

 -  Significant organ dysfunction

 -  Coagulopathy

 -  Drug or alcohol abuse

 -  Epilepsy and psychiatric illness that would interfere with perception and assessment
 of pain