Theodor Bilharz Research Institute

Propofol is currently the most common drug used but has drawbacks like narrow therapeutic window and potential complications.
Dexmedetomidine is an attractive alternative due to its unique properties like minimal respiratory depression.
Studies are ongoing to find the optimal use of dexmedetomidine for these procedures. A combination of propofol and dexmedetomidine might be ideal, but the best balance between the two drugs needs further investigation.

The goal of this clinical trial is to compare the analgesic effect of melatonin, and vitamin C and their combination in patients aged 18-60 years old who will undergo major abdominal surgery with mid-line incision within an expected time of surgery from 3 to 5 hours e.g. radical cystectomy, radical prostatectomy, colectomy, sigmoidectomy, splenectomy, and CBD exploration through mid-line incision.
This study hypothesizes that using both vitamin C and melatonin together as adjuvants will cause:
More reduction in total morphine consumption in the first 24 hours postoperatively
More reduction of the incidence of chronic post-surgical pain, than using each adjuvant alone.
Participants will be allocated into three equal groups: Melatonin (M group) and vitamin C (V group), and Melatonin and vitamin C (VM group). Two hours before surgery all patients will receive the study drugs orally and will be continued for 3 days postoperative at the same time of the first administration; 10mg of melatonin for M group (Melatonin 10 mg - Puritan's Pride premium company), 1gm of vitamin C for V group (Sanso C 1000 mg - AUG pharma company), and 10mg of melatonin and 1gm of vitamin C for VM group.
Researchers will compare:
The effect of melatonin, vitamin C, and their combination on postoperative opioid consumption
The severity of postoperative pain, using the Numerical Rating Scale (NRS)
Patients' satisfaction with a three-point scale
The time of the first requirement for rescue analgesia
The effect on the incidence of chronic post-surgical pain.

Pain after laparoscopic cholecystectomy (LC) is a common complaint that prolongs hospital stay and thus increases morbidity. There are three primary sources of pain after LC, incision site, local and systemic effects of pneumoperitoneum, and post cholecystectomy wound to the liver. External oblique intercostal plane block (EOIPB) has recently been described as a novel block for upper abdomen surgery. the probable mechanism of the block with the dyeing of both the anterior and lateral branches of the intercostal nerves T7-T10. This block also provides a dermatomal sensory block at the T6-T10 level in the anterior axillary region and the T6-T9 level in the midline.