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Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs.
The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses.
In order to blunt the autonomic and somatic reflex responses to pain and to enhance subsequent restoration of the function of different body-organs as breathing, coughing, and moving easily, together with resumption of oral feeding, and early hospital discharge.
Many studies have been carried out trying to find a solution for these dilemma thus different pain modalities as local infiltration of the surgical field, systemic analgesia (narcotics and non-narcotics), neuro-axial blocks, and nerve blocks shined out, however each has shown its side effect which limits its use to specific cases.
The patients will be randomly divided into two groups using their computer-generated random numbers will be enrolled in group D for bupivacaine-dexmedetomidine and group M for bupivacaine-magnesium
This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of pain conduction in C-fibers (Gaumann et al. 1994), decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels (Kim and Hahn 2000), and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia.
Pre-skin incision wound infiltration with dexmedetomidine–bupivacaine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.