الفهرس 
Introduction
Anatomy of Spinal CordOnly 14 pages are availabe for public view
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Abstract
The most significant component for patients postoperatively is analgesia. As a result, it’s critical to give effective analgesia in a safe manner. Cesarean section is a difficult procedure that needs proper analgesics thereafter. Appropriate pain management is critical to facilitating functional recovery and allowing patients to quickly recuperate and resume their daily activities.
In situations of caesarean section (CS) delivery, most anesthesiologists recommend spinal anaesthesia over general anaesthesia (GA) because it reduces the risk of aspiration, eliminates the newborn depressive impact of GA, and offers postoperative analgesia. It does, however, have drawbacks, Short duration of anaesthesia, hypotension, and bradycardia, as well as a lack of control over the amount of blockage, inadequate visceral block with visceral discomfort, and the risk of nausea and vomiting, particularly during uterine manipulation and peritoneal closure.
The most often used medication for spinal anaesthetic, bupivacaine, has a gradual onset, great potency, and brief postoperative analgesia. Hyperbaric bupivacaine intrathecal (IT) doses for CS vary from 12 to 15 mg. Intraoperative visceral discomfort is caused by peritoneal tension and manipulation of intraperitoneal organs during caesarean birth. Increasing the dosage of hyperbaric bupivacaine reduces the incidence of intraoperative visceral pain, but it comes at the cost of a larger risk of blockage and accompanying side effects.
General anaesthesia (GA) or regional anaesthetic are used for caesarean sections. The recommended method is subarachnoid blockage. It eliminates GA’s depressive impact on the newborn, as well as the risk of aspiration, and provides greater postoperative pain treatment. Hyperbaric bupivacaine, the most often used local anaesthetic, has a limited impact that lasts 1.5–2 hours. It has a gradual start and a brief period of postoperative analgesia.
Intrathecally administered adjuvant medicines increase the length and quality of the blockade and extend postoperative analgesia. Alpha2 agonists, neostigmine, opiates, ketamine, and other adjuvants are utilised, but no medication has been developed that selectively inhibits nociception without causing adverse effects. Nalbuphine is a synthetic opioid that acts as both an agonist and an antagonist. The binding to muscarinic receptors displaces other agonists without creating any agonist effect; nalbuphine is one example of this. As a result, the negative effects of mu agonists are lessened (nausea, vomiting, respiratory depression, urinary retention, pruritis, and prolonged sedation). In the brain and spinal cord, nalbuphine acts as an agonist (analgesic) when it binds to the kappa receptors. Nalbuphine’s neurotoxicity has not been studied.
Adjuvant hyperbaric bupivacaine and nalbuphine/midazolam effects on spinal blockade characteristics, postoperative analgesia and impacts on women and newborns after caesarean section were the major objectives of this study.
This randomized controlled trial included 90 women who were having a caesarean section under spinal anaesthesia. The women were divided into three groups: group C (control group) received 2 ml (10 mg) hyperbaric bupivacaine (0.5 percent) plus 0.5 ml normal saline, group N (Nalbuphine group) received 2 ml (10 mg) hyperbaric bupivacaine (0.5 percent) plus 0.5 ml (1mg Nalbuphine in 0.5 ml normal saline), and group M (Midzolam
The main findings of the study revealed that:
There was no statistically significant difference between the three studied groups regarding age, height, weight and duration of surgery.
there was significant decrease in heart rate throughout follow up in group C, group N and group M while there was no statistically significant difference between the three groups regarding heart rate at baseline, at 15 min., at 30 min. and at 1 hour.
There was significant increase in MAP throughout follow up in group C, group N and group M while there was no statistically significant difference between the three groups regarding MAP at baseline, at 5 min., at 15 min., at 30 min., at 1 hour and at 4 hours
there was no statistically significant difference in O2 saturation throughout follow up in group C, group N and group M. Also, there was no statistically significant difference between the three groups regarding O2 at baseline, at 15 min., at 30 min. and at 1 hour.
the onset of sensory block was significantly rapid in group N (2.05± 0.40 min) compared to group M (2.53± 0.40 min) (p= 0.002) and group N was significantly rapid compared to group C (3.02± 0.72 min).
The duration of motor block was 220.73± 15.74 min in group N, 196.67± 17.86 min in group M, and 146.70± 19.08 min in group C. The difference was statistically significant (P<0.001). It was more prolonged in group N and least in group C. It also was statistically significant different between groups (C, N), (C, M) and between (N, M).
There was statistically significant difference between the 3 groups all-over the study period except at 2hours. VAS score at 4,8 and 24 hours was significantly lower in group (N) than group (M) and group (N) was significantly lower than group (C) at 4, 16 and 24 hours (p<0.001) but there were no significant differences between groups (M) and (C) throughout study period except at 16 hours which was significantly lower in group (M) than group (C). Within each group, there were statistically significant differences between baseline values and all subsequent values in the 3 groups.
The total analgesic requirement administered in the first 24 hours were highly statistically increased in group C compared to groups N (p= 0.001) and in group M compared to groups N (p= 0.005), with no significant difference between group C and group M.
There was no significant difference between the three groups regarding nausea, vomiting and shivering (p>0.05).
Regarding APGAR score at 1 and 5 minutes, we found that Apgar score at 5 minutes was lowest in group M (8.43±0.73) compared to group C (9.03±0.81) with statistically significant difference (p= 0.03) without any danger to the baby, and no statistically significant difference between groups at 1 minute
Based on our findings, we recommend for further larger study on larger scale to emphasize our conclusion.