الفهرس 
Anatomy of spinal nervesOnly 14 pages are availabe for public view
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Abstract
Thoracolumbar interfascial plane block (TLIP) is a technique by which dorsal rami of the thoracolumbar nerves are blocked by injecting a local anesthetic drug into the fascial plane between the multifidus and longissimus muscles guided by ultrasound, at the level of the corresponding vertebra at which the surgery will be done as the local anesthesia will spread two levels above and two levels below. Bupivacaine is the most commonly used local anesthetic for nerve blocks, however, its duration of action is a major limiting factor so adding adjuvants like epinephrine, dexamethasone, midazolam, ketamine, and dexmedetomidine, which is a selective α-2 agonist that can provide analgesia by decreasing the availability of epinephrine and norepinephrine on post-synaptic α-2 receptors. This is done by a negative feedback mechanism produced by its central action on presynaptic α-2 receptors. The surgical insult activates the neurohormonal system and the inflammation response. Afferent nerve signals derived from the surgical site stimulate the hypothalamus to release corticotropinreleasing hormone then stimulates the secretion of adrenocorticotropic hormone from the anterior pituitary finally stimulates cortisol secretion by the adrenal cortex. Entropy is a useful monitor for assessing the depth of anesthesia, parameters range from 0 (suppression state of EEG) to 100 (awake) for RE, and from 0 to 91 for SE, and the adequate depth of anesthesia is obtained at range between 40-60. The aim of the study was to compare the effect of dexmedetomidine with bupivacaine versus bupivacaine alone when used in the ultrasound-guided thoracolumbar interfascial plane block in spine surgeries (lumber and lower thoracic T11-T12), regard the postoperative pain as the primary outcome and stress response, consumption of inhalational anesthesia, postoperative analgesia, and total consumption of narcotic drugs as the secondary outcome.