Cesarean birth is a common surgical procedure. After cesarean birth, postsurgical pain may delay recovery, interfere with maternal-newborn bonding, and reduce the breastfeeding if not adequately controlled. Postpartum analgesia has become a common concern.
Many adjuvant drugs used for peripheral nerve blocks as( N-methyl-d-aspartate (NMDA) receptor antagonists , Magnesium , Ephedrine , Dexamesathone , Fentanyl , Midazolam and Neostigmine) The potential of neostigmine as an adjuvant in peripheral nerve block is through its action to increase acetylcholine at muscarinic junctions of peripheral nerves. 500 mcg neostigmine was used as adjuvant to local anesthetic in an axillary brachial plexus block leads to decreased pain and less use of analgesics in the first 24 hours postoperatively with no incidence of adverse effects.
Age from 19 to 40 years old
American Society of Anesthesiologists (ASA) physical status II patients
Singleton pregnancies with a gestational age of at least 37 weeks.
Patients undergoing spinal anesthesia for cesarean delivery via a Pfannenstiel incision with exteriorization of the uterus.
Age < 19 or > 40 years.
Height<150 cm, weight < 60 kg, body mass index (BMI) ≥40 kg/m2.
Inability to comprehend or participate in the pain scoring system.
Contraindications to spinal anesthesia (Coagulopathy, increased intracranial pressure, or local skin infection).
Parallel
Bupivacaine-Neostigmine
Drug20 mL bupivacaine 0.25% plus 1 mL Neostigmine (500 mcg)
Bupivacaine
Drug20 mL bupivacaine 0.25% plus 1 mL normal saline 0.9%
The time of the first postoperative analgesic requirement
during the first 24 postoperative hours
Total amount of the postoperative analgesic drugs (ketolac, paracetamol and fentanyl) consumed in the
mg
The visual analog scale (VAS) scores during rest
11-point VAS (where 0 for no pain and 10 for the worst possible pain) at 0, 2, 4,6,12 and 24 hours postoperatively
The visual analog scale (VAS) scores during movement
11-point VAS (where 0 for no pain and 10 for the worst possible pain) at 0, 2, 4,6,12 and 24 hours postoperatively
Mean arterial blood pressure (MBP)
mmHg
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