Background: Neuraxial analgesia is the gold standard for conducting painless labor either by epidural route or combined spinal epidural. Aim of Study: This study is to evaluate the effect of adding neostigmine to levobupivacaine for epidural labor analgesia on mother and neonate. Patient and Methods: After approval from local ethical committee and obtaining written informed consent this prospective randomized double-blind study was conducted on 60 laboring mothers, aged between 21 to 38 years, ASA I & II, single pregnancy, gestational age >!37 weeks in active cervical dilatation (!95cm) subjected to normal labor by epidural analgesia. Parturient were randomly divided into two groups: Group L (n=30): Received 15ml of 0.125% levobupivacaine. Group N (n=30): Received 15ml of 0.125% levobupivacaine + 6mic/kg neostigmine. Onset of sensory block, duration of analgesia, maternal hemodynamics, motor block and total dose of levobupivacaine were recorded. Maternal outcome in the form of (duration of labor, mode of delivery), Apgar score at (1 and 5min) and side effects were also recorded. Results: There was faster onset of sensory block and prolonged duration of analgesia with neostigmine group compared with other group. No significant difference between both groups as regard hemodynamics. No motor blockade in both groups. There was significant reduction in the total dose of levobupivacaine with neostigmine group. There was shorter duration of labor with neostigmine group. No significant difference as regard mode of delivery, Apgar score and complications between the two groups. Conclusion: Neostigmine can be utilized as a safe adjuvant with levobupivacaine to provide a better quality of analgesia and reduce dose of local anesthetic during management of labor pain. Also it's safe for both mother and fetus.

Background:The transversus abdominis plane block (TAP block) can give a good analgesia after lower abdominal surgery. The administered local anesthetics determine the TAP block duration, so administration of adjuvants can be utilized to extend local anesthesia time and increase efficiency. Aim of the work:To assess the efficacy of TAP block with dexamethasone on pain relief after lower abdominal gynecological procedures. Patients and methods: A randomized controlled study was performed on 100 women, aged 25-56 years, ASA I&II. Listed for lower abdominal gynecological procedures under general anesthesia, TAP block was performed bilaterally at the end of surgery. Patients were randomly divided into two groups: Group I (n=50) bilaterally received 15ml of 0.2% levobupivacaine plus 1.5 ml normal saline. Group II (n=50) bilaterally received 15 ml of 0.2% levobupivacaine plus1.5 ml) 6 mg (Dexamethasone. The primary outcome was visual analogue score (VAS) to assess postoperative pain. The secondary outcomes were the time to first analgesic request, number of patients needed meperidine, overall dose of analgesic consumption/24h and complications. Results: VAS was significantly lower for 12h at rest and for 10h on activity in group II compared to group I (P<0.001), prolonged time to first analgesic request (P <0.001) and less meperidine requirement in group II (P <0.001). Conclusion:Combination of dexamethasone to levobupivacaine in TAP block was effective in decreasing the severity of postoperative pain, overall meperidine consumption and prolonging the time to first analgesic request after lower abdominal gynecological procedures.

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Background: Cesarean delivery is a frequently obstetric operation in Egypt with a recently reported over all cesarean section rate of 54% and it causes moderate to severe postoperative discomfort. Infiltration of the wound site is a method to improve postoperative analgesia. The aim of the work:To compare the pain relief effects of ketamine versus dexmedetomidine combined to bupivacaine in local wound infiltration in patients undergoing cesarean section and to estimate side effects of medications. Patients and Methods:This randomized, controlled study including 90 women were subjected for elective cesarean delivery under general anesthesia and were divided at random into 3 equal groups to receive 40 ml bupivacaine [0.25%] + either 2 mg/kg ketamine in [group A], 2 μg/kg dexmedetomidine in [group B] or 2 ml saline in [group C] via local wound infiltration. The primary outcome was the time of the first analgesia requested. The secondary outcomes were total dose of analgesia per 24 hours, visual analogue scale, the time of starting movement, breast-feeding, passing flatus or stool, start of eating and adverse effects of medications. Results: A significant increase in time of the first analgesic request in group A [8.4 ±1.91] h. and group B [7.5±1.81] h. than group C [4.3±1.24] h. A significant decrease in pethidine consumption in group A [59 ± 28.93 mg] than group B [72 ± 23.1 mg] and group C [102 ±16 mg]. The visual analogue scale [VAS] was significantly lower [p<0.001] in groups A and B than in group C. The time of start movement, breast-feeding, passing flatus and eating was decreased in groups A and B than in group C Conclusions: Addition of ketamine or dexmedetomidine to local anesthetics wound infiltration increased time to the first analgesia request and decreased total analgesic consumption, but ketamine is superior.