This study aims to compare the efficacy of adding dexamethasone and magnesium sulfate as an adjuvant to bupivacaine in bilateral erector spinae block in postoperative pain control in patients undergoing caesarean section under spinal anesthesia.
Age from 18 to 35 years.
Full-term, singleton, pregnant women.
American Society of Anesthesiologists (ASA) physical status II.
Scheduled for elective cesarean delivery under spinal anesthesia.
Refusal of the patient.
Emergency caesarean sections.
Patients having chronic diseases as asthma, cardiovascular disorders (Significant arrhythmias, Severe Valvular diseases, congenital heart diseases, ischemic heart disease, cardiomyopathy, deep venous thrombosis ,and pulmonary embolism)
Renal impairment (Creatinine level ≥ 2mg/dl, urea ≥ 25mg/dL), liver impairment [Alanine aminotransferase (ALT) < 45 U/L, Aspartate aminotransferase (AST) < 45 U/L].
Parallel
Bupivacaine
DrugPatients will receive 20 ml of 0.25% isobaric bupivacaine.
Dexamethasone
DrugPatients will receive 20 ml of (0.25% isobaric bupivacaine and 4mg of dexamethasone).
Magnesium sulphate
DrugPatients will receive 20 ml of (0.25% isobaric bupivacaine and 200mg of magnesium sulphate).
Time to first analgesic requirement
Time to first analgesic requirement in the following 24 hours after cesarean delivery. It is the time elapsed between performing the assigned intervention and first morphine requirement.
Degree of pain
Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded at 1, 2, 4, 6,18 and 24 h postoperatively.
Obstetric Quality of Recovery
Obstetric Quality of Recovery (ObsQore) aims to measure functional recovery at 24 hours postpartum quantitatively. It includes 11 questions on a 0 to 11 scale, and the results are tabulated out of 100. The higher the overall score out of 100, the better quality of recovery a patient is experiencing, aimed at pain management, the adverse effects of narcotics, and the perception of recovery by the patient.
Total morphine consumption
Rescue analgesia in the form of morphine 0.05 mg/kg will be given when the Visual Analogue Scale (VAS) is more than 3, with a total maximum of 20mg morphine / 24hrs.
Time to independent movement
Time to independent movement defined as time from performing the intervention to be able independently mobile e.g. using the bathroom, care for the baby).
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