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Background and Aims Opioids form the vital part of anesthesia. However, in addition to their beneficial effects they also have side effects and addictive potential. Due to these side effects modern physicians try to minimize their use as sole analgesic agents. Therefore, this study is planned to compare the efficacy of Dexmedetomidine-ketamine with that of propofol-ketamine foradult patients undergoing brachial plexus injury repair under TIVA and look at opioid free anaesthesia feasibility. Aim of the study: To compare the efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations of TIVA for opioid free anesthesia in adult patients undergoing brachial plexus injury repair. Primary objective: To compare the requirement of additional analgesic dose of ketamine intraoperatively Secondary objectives: Time to first rescue analgesia, Total Analgesia requirement in 24hrs

Methods Prospective, Double blinded, Randomized Controlled study. After intubation, patients in both groups received ketamine as infusion at rate of 1mg/kg/hr. Group I (propofol-ketamine)N=17 Propofol: 0.6*weight (in Kg) ml/hr Group II (dexmed-ketamine)N=18 Dexmedetomidine: 0.125*weight (in Kg) ml/hr. Total additional ketamine required noted. Time to first rescue analgesic and total requirement in 24 hours was noted.

Results Mean ketamine consumption in propofol-ketamine group was 302.52±47.49 mg and in dexmed-ketamine group was 356.16±43.11mg. Time to first rescue analgesia was 52.0±10 minutes in propofol-ketamine group while it was 81.3±15 minutes in dexmed-ketamine group.

Conclusions It is feasible to provide opioid free anesthesia as TIVA for adult patients undergoing brachial plexus injury repair under using propofol-ketamine or dexmed-ketamine combinations.