COMPARISON BETWEEN KETAMINE AND NEOSTIGMINE AS ADJUVANTS TO BUPIVACAINE IN ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK IN CAESAREAN SECTION

INTRODUCTIONCaesarean section (CS) requires effective postoperative pain management to enhance maternal comfort, facilitate early mobilization, and reduce complications such as thromboembolic events and impaired maternal-infant bonding. While systemic opioids have traditionally been used, their adverse effects have led to the adoption of multimodal analgesia, including regional techniques like the transversus abdominis plane (TAP) block. TAP blocks provide targeted analgesia by delivering local anesthetics between the internal oblique and transversus abdominis muscles, reducing systemic drug exposure. However, their duration is limited to 12–24 hours with plain bupivacaine. To prolong analgesia, adjuvants such as ketamine and neostigmine are increasingly used. Ketamine, an NMDA receptor antagonist, prevents hyperalgesia and central sensitization, while neostigmine, an acetylcholinesterase inhibitor, enhances cholinergic neurotransmission to extend analgesic effects. This study evaluates the efficacy and safety of these adjuvants in TAP blocks for CS, focusing on pain relief, duration of analgesia, opioid-sparing effects, and patient outcomes. AIM OF THE WORKThe primary objective of this study was to compare the efficacy of ketamine and neostigmine as adjuvants to bupivacaine in ultrasound-guided TAP blocks for elective CS, with a focus on postoperative pain intensity and analgesia duration. Secondary objectives included assessing differences in rescue opioid consumption, patient satisfaction, and the incidence of complications such as haemodynamic instability or side effects.