Dexamethasone With TAP Block Increasing the Duration of the Peripheral Nerve Block in Caesarian Section

Study Overview
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Brief Summary
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Nowadays Cesarean sections became the most popular surgery worldwide with the consumption of the hospital resources and the continuous need to decrease the costs, work load and medical stuff engagement. One of the most common problem is the need to control pain post operatively, this issue increase the work load over the pain management team and increase lead to patient in satisfaction. This study will test the usage of dexamethasone with different doses (4 and 8 mg) either locally or intravenously (I.V.) with the local anesthetics in TAP (transversus abdominis plane) block to prolong the duration of the block and decrease the need of post-operative analgesics.

Detailed Description
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Nowadays Cesarean sections became the most popular surgery worldwide with the consumption of the hospital resources and the continuous need to decrease the costs, work load and medical stuff engagement. One of the most common problem is the need to control pain post operatively, this issue increase the work load over the pain management team and increase lead to patient in satisfaction.(1,2,3) The presence of the adjuvant which can be added to the conventional anesthetic medications can prolong the duration of action and decrease the need for frequent post-operative analgesics.(4,5) The idea of adding a catheter or placing an epidural catheter still have a quite limitation regarding the patients compliance, delayed ambulation and high costs, these limitations redirect the anesthetist again to the use of adjuvant with a single shot block to prolong the duration of it and decrease the need of subsequent analgesics.(6) Dexamethasone proved to be an effective adjuvant in prolongation of the nerve blocks with the question regarding the proper route and dose (7,8,9,10). This study will test the usage of dexamethasone with different doses (4 and 8 mg) either locally or intravenously (I.V.) with the local anesthetics in TAP (transversus abdominis plane) block to prolong the duration of the block and decrease the need of post-operative analgesics.

Official Title
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Dexamethasone With TAP Block Increasing the Duration of the Peripheral Nerve Block in Caesarian Section

Conditions
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Pain

Intervention / Treatment
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* Drug: Dexamethasone in addition to TAP block in dose of 4 mg
* Drug: Dexamethasone in combination with TAP block in dose of 8 mg
* Drug: Dexamethasone intravenous 4mg+ TAP block
* Drug: Dexamethasone intravenous in addition to TAP block in dose of 8 mg
* Other: control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any patient ASA (american society of anesthesia) I or II, aged between 18 and 45 scheduled for elective cesarean section. Exclusion Criteria: patient refusal, age below 18 or above 45 years, coagulopathy with INR (international normalized ratio) more than 1.5 or platelets below 100000, uncontrolled diabetes, uncontrolled hypertensive, addict patient, psychological instability, and allergy to the used drugs, failure of spinal, conversion to general of anesthesia, failure of application of TAP block.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: CONTROL<br>TAP block without Dexamethasone neither intravenous nor in combination with the block | Other: control<br>* TAP block without Dexamethasone neither intravenous nor in combination with the block<br>* Other names: control group;|
| Experimental: Group 2 (TD8IS)<br>Dexamethasone in combination with TAP block in dose of 8 mg | Drug: Dexamethasone in combination with TAP block in dose of 8 mg<br>* Dexamethasone in combination with TAP block in dose of 8 mg<br>|
| Experimental: Group 3(TD4IS)<br>Dexamethasone in addition to TAP block in dose of 4 mg | Drug: Dexamethasone in addition to TAP block in dose of 4 mg<br>* Dexamethasone in addition to TAP block in dose of 4 mg<br>|
| Experimental: Group 4 (TSID8):<br>Dexamethasone intravenous in addition to TAP block in dose of 8 mg | Drug: Dexamethasone intravenous in addition to TAP block in dose of 8 mg<br>* Dexamethasone intravenous + TAP block in dose of 8 mg<br>* Other names: Dexamethasone intravenous 8mg+ TAP block;|
| Experimental: Group5(TSID4)<br>Dexamethasone intravenous 4mg+ TAP block | Drug: Dexamethasone intravenous 4mg+ TAP block<br>* Dexamethasone intravenous in addition to TAP block in dose of 4 mg<br>* Other names: Dexamethasone intravenous 4mg + TAP block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| level of pain according to verbal analogue scale |  | THREE DAYS |