Aim: To compare onset , duration and analgesic efficacy of axillary block when dexamethasone or ketorolac added to local anaethetic .
. Patient and Methods: 60 patients aged 18-65 years with ASA I-II  who were candidate for distal upper limb surgeries by axillary nerve block were enrolled in this randomized controlled double blinded study  ,  in sohag university hospital .
.Patients were Randomly allocated to( 3) groups (20) patients each ( using sealed envelope technique ) as :
- Dexamethasone (group D): patient received 30 ml  of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml .
- ketorolac (group K):patient received 30 ml  of 0.375 bupivacaine plus  30mg ketorolac in 2ml.
- control (group C) : patient received 30 ml  of 0.375 bupivacaine and normal saline 2ml).Immediately after administration; the patients were turned into the supine position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block; In the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS). Complications also were observed .Results: Dexamethasone had a faster Onset of sensory block onset than Magnesium Sulphate; Dexamethasone had a longer duration of regard Duration of motor block than Magnesium Sulphate; Magnesium Sulphate group had a longer analgesic effect stayed longer than Dexamethasone group .No Significant difference Between Two groups in rate of Complications ; Hypotension and Bradycardia were the most frequent complications in the two groups .Conclusion: The addition of dexamethasone to bupivacaine resulted in significant reduction in onset time of sensory and motor blocks, prolonged duration of post operative analgesia, lower analgesic consumption and lower incidence of complications