Post-operative Analgesic Effect of Dexmedetomidine and Dexamethasone as Adjunct in Transversus Abdominis Plane Block During Cesarean Section

Background: Effective postoperative pain control after cesarean delivery enhances maternal recovery and neonatal care. Ultrasound-guided transversus abdominis plane (TAP) block is a key component of multimodal analgesia. Adjuvants such as dexmedetomidine or dexamethasone may extend block duration. This study compared their analgesic efficacy and safety when combined with bupivacaine in TAP block.Methods: In this randomized controlled trial, 42 women undergoing elective cesarean section under spinal anesthesia at Al-Hayah Port Fouad Hospital were allocated into three equal groups: Control—40 ml 0.25% bupivacaine + saline; DMD—38 ml bupivacaine + dexmedetomidine 100 μg; DEXA—38 ml bupivacaine + dexamethasone 8 mg. Primary outcome: time to first rescue analgesia. Secondary outcomes: postoperative VAS scores, total analgesic consumption, sedation, and adverse events within 24 h.Results: Dexmedetomidine significantly prolonged analgesia, reduced VAS scores during the first 18 h, and lowered total analgesic use compared with dexamethasone (p < 0.001), but caused more transient bradycardia and hypotension.Conclusions: Dexmedetomidine provided superior analgesia but with more hemodynamic effects. Dexamethasone offered slightly shorter analgesia with a safer profile, favoring its use in patients with cardiovascular risk.