الفهرس 
Anatomical ConsiderationsOnly 14 pages are availabe for public view
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Abstract
Different anesthesia techniques have been implemented to decrease postoperative pain following laparoscopic cholecystectomy. intra peritoneal instillation of local anesthetics is gaining popularity for better pain relief.
The local anesthetic agents provide anti nociception by affecting nerve membrane-associated proteins and by inhibiting the release and action of prostaglandins which stimulate the nociceptors and cause inflammation Many adjuvants like epinephrine, clonidine, opioids, ketamine, and midazolam were combined with local anesthetics to prolong the duration of analgesia but have met with limited success. However, the glucocorticoid dexamethasone has been shown to be effective in a small number of preclinical and clinical studies.
The antinociceptive effect of magnesium sulphate is not only useful in chronic pain, but it also determines in part, the duration and intensity of postoperative pain. These effects are due to calcium antagonism and decrease influx of calcium into the cell and antagonism of NMDA receptor. As these receptors regulate neuronal signalling and are involved in pain processing, magnesium sulphate by blocking this receptor, decreases postoperative pain as well.
Our study was conducted in Menoufia University Hospitals to study the effect of intra peritoneal instillation of bupivacaine or bupivacaine plus magnesium sulphate or bupivacaine plus dexamethasone on post-operative pain after laparoscopic cholecystectomy. Sixty patients with ASA physical status I- II,