الفهرس 
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Abstract
Laparoscopic hysterectomy may cause different types of pain, patients undergoing laparoscopic approaches that have the reputation of being less painful, were found to receive inadequate pain relief and experience high levels of postoperative pain (Gerbershagen et al., 2013).
As such, the postoperative pain after laparoscopic hysterectomy is often difficult to control, which leads to increased opioid use, it also affects mobility which endanger the patient by the risk of thrombo embolic complications, as well as a delay of recovery and prolonged hospital stay despite being a minimally invasive laparoscopic surgery (Ekstein et al., 2006).
Local anesthetics block the visceral afferent signals and modify visceral nociception & also they provide antinociception by affecting nerve membrane associated proteins and by inhibiting the release of prostaglandins that stimulate the nociceptors and boost the inflammatory process.(Marwa et al, 2019).
Bupivacaine: is a long-acting local anesthetic that effectively reduces postoperative pain(Hortu et al., 2020). Adjuvants like Alpha 2 agonists (dexmedetomidine)are medications that work synergistically with local anesthetics to help enhance the duration and quality of anesthetic effects have shown to increase the duration of anesthesia significantly(Amit Prbhaka et al., 2019).
The aim of this study was to evaluate the analgesic efficacy of intraperitoneal instillation (IP) of bupivacaine with dexmedetomidine as adjuvant for Post-operative pain management in laparoscopic Hysterectomy.
In this study, 30 female patients scheduled for laparoscopic hysterectomy where included and divided into two groups, 1: group {A}: (n=15) patients of this group received Bupivacaine (Marcaine) &Dexmedetomidine and 2:Group{B}(n=15) in which patients of this group received intraperitoneal local anesthetic (bupivacaine).
Informed consent was obtained from 30 patients. One participants in the group A were withdrawn by the investigators because of changes in the surgery performed that precluded inclusion (converted from laparoscopic Hysterectomy to Abdominal Hysterectomy).
After obtaining a consent, subjects will be enrolled for laparoscopic hysterectomy then after finishing the hysterectomy, prior to removal of trocars a local anesthesia will be instilled intraperitoneally according to the group.
Before the induction of anesthesia, the patients were instructed on how to use visual analog scale (VAS), which is a psychometric scale that is mostly used in pain scale surveys to understand varying degrees of pain experienced by a patient.
This study found that there was no statistically significant difference between two groups according to Age, BMI, Parity, Obstetric History, Medical, surgical and family history, indication and Type of hysterectomy, Duration of Surgery and uterine size.
This study also shows that the visual analogue scores for patients at 1, 6, 12and 24 hours post-operative were statistically significantly higher in the group B compared to group A with p-value is <0.001.
This Study also found out that Need for Post-Operative rescue analgesia statistically significant with P-value <0.05..
We Found also that The side effects such as nausea and vomiting were also less in group (A) than in group B, but their difference was not statistically significant (p>0.05)
There was a significant increase in the time required for 1st rescue analgesia in group A more than group B, Amount of Analgesia needed was significantly less in group A compared to group B. also the hospital stay was significantly less in group A compared to group Bp < 0.05
Limitation of the present study is the post operative pain, which is a subjective experience and can be difficult to quantify objectively and compare when comparing various treatment options.