الفهرس 
Maternal and Fetal PhysiologyOnly 14 pages are availabe for public view
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Abstract
Spinal anesthesia for cesarean delivery is the best anesthetic technique as it is
simple to perform with rapid onset of anesthesia and complete muscle relaxation. Lower
incidence of failed block, less drug doses, minimal neonatal depression and decreased
incidence of aspiration pneumonitis are added advantages of spinal anesthesia
Adding adjuvant drugs to intrathecal local anesthetics improves quality and
duration of sensory blockade and prolongs postoperative analgesia. Intrathecal opioids
are synergistic with local anesthetics, thereby intensifying the sensory block without
increasing sympathetic block.
Nalbuphine, a mixed agonist–antagonist opioid, has a potential to attenuate the
mu-opioid effects and to enhance the kappa-opioid effects. It was synthesized in an
attempt to produce analgesia without the undesirable side effects of a l agonist. Also, its
combination with l agonist opioids was tried by many researchers.
Among other adjuvants, adenosine showed initial promise because of its analgesia
mediated at the spinal adenosine receptors and inherent anti-inflammatory actions without
any neurotoxicity in initial animal studies.
After animal toxicity testing suggested safety, a phase I dose-ranging trial of 0.25–
2 mg of intrathecal adenosine in healthy volunteers showed no effect on arterial blood
pressure, end-tidal carbon dioxide, or neurologic function; headache and back pain were
common side effects.
The aim of this study is to measure the perioperative fetal and maternal out come
and the post-operative analgesic effect when using intrathecal Nalbuphine as an adjuvant
to Bupivacaine and intrathecal Adenosine as an adjuvant to Bupivacaine during spinal
anaethesia for elective cesarean section.
After approval of ethical committee on our study, patients admitted to El
Menoufia University Hospital for cesarean delivery will be enrolled in this study.
The exclusion criteria for this result includes;
Patient refusal.
Infection at site of the injection or systemic infection.
Patients having any coagulopathy disorder or receiving any anticoagulant drugs.
Preexisting neurological disorders.
Pre eclampsia and eclampsia.
Patients with signs suggesting cardiac or respiratory system diseases.
Patients with known history of allergy to local anesthetics drugs.
Hypertensive and Diabetic patients.
The parturients were randomly divided into 2 groups.
o group A (Adenosine): This group was received intrathecal 2.4 ml of 0.5% heavy
Bupivacaine plus 500 mcg Adenosine (USP) as an adjuvant.
o group N (Nalbuphine): This group was received intrathecal 2.4 ml of 0.5%
heavy Bupivacaine plus 400 mcg Nalbuphine (nalufin) as an adjuvant.
Accordingly, we calculate that the minimum proper sample size was 25 patients
in each group to be able to reject the null hypothesis with 80% power at α = 0.05 level
using one-way analysis of variance test. Sample size calculation was done using G*Power
software version 3.1.2 for MS windows, Franz Faul, Kiel University, Germany.
Level of sensory block had been assessed using loss of cold discrimination (ice
test), and motor block (assessed by Bromage scale; 0 =none, 1 =just able