Background: Subarachnoid block achieved a wide spread popularity as a simple and effective method of anesthesia for elective cesarean sections. Among the local anesthetics, bupivacaine is the most commonly used drug for subarachnoid block. Aim of the Work:This study was conducted to evaluate and compare the effects of intrathecal midazolam and fentanyl as additives to intrathecal hyperbaric bupivacaine with regards to onset and duration of sensory block, duration of complete and effective analgesia and side effects associated with the drug. Patients and Methods: This study included 90 women aged between 18-35 years scheduled to undergo elective cesarean section under spinal anesthesia. Patients were subdivided randomly into 3 groups (30 patients each) on the basis of the adjuvant added to the anesthetic used; group A (Fentanyl + bupivacaine), group B (Midazolam + bupivacaine) and group C (Bupivacaine).Results: Demographic data did not differ between the three study groups (p > 0.05). Group A showed a significantly earlier onset of sensory block (p =0.005), motor block (p = 0.009), as well as late regression to L1 sensory level (p <0.001). Additionally, longer analgesia (p < 0.05) and longer time before the first call for analgesics (p = 0.005) was associated with group A. The required dose of paracetamol and pethidine within the first day were significantly lower in group A and group B in comparison to group C. However, complications encountered did not differ between the three study groups (p > 0.05). Also, the state of the neonates didn't show significant difference between the three groups. Conclusion:Intrathecal adjuvants are associated with improving out comes after CS as revealed by delayed onset and longer duration of sensory and motor block in addition to longer duration of complete and effective analgesia. Intrathecal fentanyl revealed better outcomes in terms of delayed onset and longer duration of sensory and motor block in addition to longer duration of complete and effective analgesia as compared with midazolam.

Background This prospective randomized controlled double-blind clinical study was conducted on 52 patients of both genders divided into two groups (26 patients each). Local anaesthetic solution of isobaric bupivacaine 0.25% (0.3 ml/kg) was prepared. Group A received bilateral transversus abdominis plane (TAP) block with bupivacaine and dexamethasone (0.3 mg/kg) while group B received bilateral TAP block with bupivacaine and volume of saline equal to the amount of dexamethasone given in group A. Patients were observed for FLACC pain scale at the time of discharge from the post-anaesthesia care unit and then every 2 h for 36 h after the operation. This study was conducted to assess the safety and efficacy of adding dexamethasone to bupivacaine on the quality of bilateral US-guided transversus abdominis plane (TAP) block in children undergoing major abdominal surgery Results Dexamethasone added to local anaesthetic in ultrasound-guided TAP block significantly decreased FLACC score at 8, 10, and 12 up to 24 h postoperatively, The time to the first requested analgesia was prolonged in the dexamethasone group (P = 0.000). The total dose of acetaminophen consumption over 36 h after surgery was also reduced (P = 0.000), but no difference was found regarding the total dose of rectal diclofenac (P = 0.068). Conclusion Adding dexamethasone to isobaric bupivacaine TAP block reduces postoperative pain and analgesic requirements compared to isobaric bupivacaine TAP block alone in children undergoing major abdominal surgery.