Comparing the effect of Magnesium sulphate with Bupivacaine versus Dexmedetomidine with Bupivacaine versus plain Bupivacaine in Transversus Abdominis Plain block for post operative analgesia in patient undergoing Elective Lower Segment Caesarean section

The objective of the study is to compare the effect of magnesium sulphate with bupivacaine versus dexmeditomidine with bupivacaine versus dexmeditomidine with bupivacaine versus plain bupivacaine in transversus abdominis plane block in patients undergoing elective LSCS .

Every patient will undergo pre anaesthetic assessment and a informed written consent will be obtained after explaining about the block. Patients will be kept NPO for 6 hours prior to surgery. On arrival in the operating room patient will be connected to the monitors such as electrocardiogram, pulse oximeter, and non-invasive blood pressure monitor. A 18 gauze peripheral venous cannula was inserted and intravenous fluid will be administered.

Patients will be monitored for hemodynamic parameters such as heart rate, systolic blood pressure and diastolic blood pressure and saturation in the above mentioned intervals.

They will be randomly divided into three groups.

Group B     -   30 patients will receive only 20 ml of  inj bupivacaine 0.25 %  on each side and 2 ml of normal saline.

Group BM  -   30 patients will receive 20 ml of  inj bupivacaine 0.25 %  on each side and 0.5 ml of normal saline and 1.5 ml

of   Magnesium sulphate ( 150 mg )

GROUP BD  -  30 patients will receive 20 ml of  inj bupivacaine 0.25 %  on each side and 2ml of dexmeditomidine

(1       mcg/kg )

Under aseptic precautions at the level of L 3 – L 4 or L4 – L5 spinal anaesthesia will be given. Inj bupivacaine 0.5 % heavy 2 ml with fentanyl as adjuvant will be used for spinal anaesthesia. Post-surgery patients will receive bilateral TAP block under USG guidance .Lateral approach for TAP block will be done.

Post procedure duration of pain free period, intensity of pain using VAS score will be monitored at intervals of 4hours, 8 hours, 12 hours, 16hours and 24 hours. Need for rescue analgesia will be monitored in the above mentioned intervals. If the need of rescue analgesia is only inj.paracetamol 1g within 24 hrs post-surgery it will be scored as 1, if it is 2g within 24 hours it will be scored as 2, and if more than 3g within 24 hours it will be scored as 3. If patient is not responding to inj paracetamol1g and the time period has not crossed more than 8hours patient will receive inj.diclofenac 75mg IV as a pain relief medication and it will scored as 4. Patient requiring more than the mentioned analgesic dose for pain relief will be excluded from the study.

Patients will be monitored for hemodynamic parameters such as heart rate, systolic blood pressure and diastolic blood pressure and saturation in the above mentioned intervals.