Comparative Study of Intravenous Versus Perineural Dexamethasone Added To TAP Block For Analgesia After Cesarean Section.

Cesarean section (CS) is commonly performed lifesaving surgical procedure to reduce fetal and maternal mortality and morbidity rates . The use of regional anesthesia, including spinal or another type of peripheral block, may prevent the pain that has moderate-to-severe intensity in the first 24 h after CS operations.The postoperative moderate-to-severe pain incidence rate after CS under spinal anesthesia accounts for 77.4% of the cases. The worst pain intensity was reported at 6 h CS operation .For these operations, adequate postoperative pain relief is crucial to facilitate early ambulation, providing good infant care (including breastfeeding, maternal-infant bonding), and preventing postoperative morbidity. If acute postoperative pain after CS is inadequately treated, there is an increased incidence of chronic pain by 10– 15% and some reports of post-traumatic stress syndrome.(1) Transversus abdominis plane block is known to provide effective postopertive analgesia in patients undergoing LSCS. Bupivacaine is one of the widely used local analgesics . Dexamethasone, a corticosteroid, provide analgesia owing to its anti-inflammatory properties. It also potentiates the effect of local anesthetics . In light of this knowledge, dexamethasone has been used as an adjuvant in various studies to improve the anesthetic effects of TAP block post LSCS operations .(2) Both perineural and intravenous (IV) dexamethasone aim to prolong the duration of analgesia (pain relief) in peripheral nerve blocks when used along with local anaesthetics. While perineural administration involves injecting dexamethasone near the nerve, IV administration delivers it systemically, and both methods are thought to reduce inflammation and potentially improve pain management.(5) Hence we plan to study the effect of perineural and intravenous dexamethasone with 30ml of 0.2% bupivacaine for bilateral transverse abdominal plane block for postoperative analgesia in LSCS surgeries.