Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Anesthesia

Pinal anesthesia is the most commonly used regional technique for cesarean section, due to its simplicity of execution, fast onset and predictable effects However, in high doses, intrathecal local anesthetics may produce high levels of sensory and motor block and hypotension. It is particularly important for parturients undergoing cesarean section, as maternal hypotension causes decreasing maternal cardiac output and uteroplacental blood flow. The addition of various additives may allow the dose of local anesthetic to be reduced, producing a synergistic effect that enhances analgesia and prolongs the duration of the sensory block without intensifying motor block Levobupivacaine produce a sensory and motor block different from that produced by bupivacaine, which is the most popular local anesthetic in parturients undergoing cesarean section. The aim of this study was to investigate the block characteristics, the clinical efficacy and hemodynamic effects of using different additives to intrathecal plain levobupivacaine All regimes were effective in providing surgical anaesthesia and haemodynamic stability, but levobupivacaine + fentanyl,& levobupivacane+ dexamedetomidine groups offered an advantage of rapid onset of sensory and motor block and prolonged duration of sensory block and postoperative analgesia, thus decreasing the doses of rescue analgesia in the postoperative period. However, prolonged motor block was unwanted as it delays early ambulation. While adding of mgso4 75mg led to significant delay in onset of both motor &sensory blockade &prolong the duration of both sensory &motor blockade without increasing major side effects .but it seemed that this drug was enough &provide effective anesthesia 75 mg of magnesium was enough to lead a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade, without increasing major side effects

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