Background: Local anesthetic adjuvants prolong analgesia duration with single shot interfascial plane blocks. They potentiate the analgesic effect of the local anesthetics. These adjuvants include several groups and different mechanisms of action such as dexamethasone and dexmedetomidine. Objectives: This study was aimed at achievement of better analgesia for total abdominal hysterectomy patients via prolongation of sensory block duration and reducing opioid consumption. Patients and Methods: This study was carried out at Zagazig University Hospitals where 84 female patients scheduled for total abdominal hysterectomy aged from 40 to 60 years, ASA physical status grade I, II and body mass index (BMI) 18.5-30 kg/m 2 . Patients were classified into three groups (28 each), group C (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1ml saline), group O (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1ml dexamethasone (4mg)), group D (received bilateral ESPB with 20 ml bupivacaine 0.25% plus 1 ml dexmedetomidine (0.5ug/kg) in saline). They underwent history taking, general examination, laboratory investigations, preoperative erector spinae plane block (ESPB) and GA. Results: There was statistically significant difference between three groups regarding visual analog scale (VAS) and nalbuphine consumption where D group had better pain control than other groups. Conclusions: It could be concluded that dexmedetomidine as an adjuvant to 0.25% bupivacaine in ultrasound guided erector spinae plane block is more efficacious than dexamethasone in hastening the onset, prolonging sensory blockade, delaying the time for request of rescue analgesia, and decreasing total nalbuphine consumption.

Background: Dexmedetomidine's potential to increase blockade duration has piqued the interest of researchers as a local anaesthetic adjuvant in recent years. As an opioid analgesic, fentanyl is highly effective. Objective: Improving postoperative analgesia after Cesarean delivery using dexmedetomidine or fentanyl as additives to bupivacaine for transversus abdominis plane block with ultrasonography guidance. Patients and Methods: One hundred and twenty cases were randomly divided into two equal groups each included 60 cases. Group D received ultrasound guided transversus abdominis plane (TAP) block using dexmedetomidine 1 microgram/kg + 40 ml bupivacaine 0.25%, and the volume was divided equally and given bilaterally. Group F received ultrasound guided TAP block using fentanyl 1 microgram/kg + 40 ml bupivacaine 0.25%, and the volume was divided equally and given bilaterally. Results: Group D had lower mean arterial pressure as well as heart rate than group F at 4, 8, 12, 18, and 24 hours post-operative. Group D had a significantly longer time to first analgesia compared to group F. Group D had significantly reduced total analgesic intake compared to group F over a 24-hour period. Rescue analgesics were needed by a greater percentage of patients in group F than in group D after 6, 12, and 24 hours. A statistically significant difference was seen between the two groups after 20 and 24 hours on the VAS, with group D scoring lower than group F. Conclusion: Dexmedetomidine was more effective than fentanyl in providing postoperative analgesia with bupivacaine for transversus abdominis plane block with ultrasonography guidance following caesarean section.

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