الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Gynecological procedures are among the most common surgeries performed on women, these operations leaves a surgical scar with debilitating postoperative pain. This pain should be adequately managed otherwise adverse effects of pain will be gained. The majority of body systems are impacted by postoperative pain side effects. It’s associated with psychological disturbance and hemodynamic changes especially in borderline cardiac patients, it affects lungs with atelectasis, respiratory depression narcotic overuse to treat the pain. It delays hospital discharge with more hospital cost. So, it’s crucial to manage postoperative pain.
Multimodal analgesia is a rising technique that permits the use of different modes of analgesia with different mechanism of actions and various methods of administration. It avoids opioid overuse and its consequences. Managing acute postoperative pain includes pharmacological (opioids, paracetamol, NSAIDS), neuraxial anaesthesia, peripheral nerve block (TAP Block, ESPB, PVPB) and wound infiltration. Adjuvant drugs, when used with single-shot peripheral nerve blocks, increase the duration and decrease the dose-dependent adverse effects of local anesthetics.
The aim of this study was comparing the effect of adding two different doses of dexmedetomidine to bupivacaine in ultrasound guided TAP block as regard the analgesic profile by using VAS score, duration of analgesia (Time of 1st request of rescue analgesia) and total amount of rescue analgesic consumed in the 1st 24 hours postoperative. Also to compare the side effects of the two different doses.
The present study was carried on 40 women aged between 20-60 year old scheduled for gynacological surgeries under general anaesthesia, in a double blinded study.
Patients were randomly categorized using closed envelope techniques into two equal groups (20patients each):
group (A): will receive TAP block contained 20 mL of bupivacaine 0.25%, supplemented with 0.5μg/kg of dexmedetomidine bilaterally.
group (B): will receive TAP block contained 20 mL of bupivacaine 0.25%, supplemented with 1.5 μg/kg of dexmedetomidine bilaterally.
Patients were evaluated properly before operation by taking history, examination and reviewing of necessary laboratory investigations. Patient are educated about the VAS score. Patients kept NPO for 8 hours before surgery.
Details of general anaesthesia plan and the technique they received was reviewed with them. Informed consents were taken.
At day of surgery, peripheral cannula was inserted. Basic monitors were attached to the patients (NIBP, ECG, pulse oximetry, ETCO2). preload fluids were given.
Induction of general anaesthesia was done by using proprofol, cisatracurium, fentanyl. Using a proper machintosh blade size to intubate the trachea. Maintenance of anaesthesia by using isoflurane, mechanical ventilation and cisatracurium. All patients were given fluids according to standardized guideline.