الفهرس 
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Abstract
ESP is one of the recent fascial plane block techniques that have been in many fields of pediatric surgeries for intraoperative and postoperative analgesia such as general surgery for example gastrostomy tube placements), urology as pyeloplasties, cardiac surgery as aortic coarctation repairs and video-assisted thoracoscopic procedures. The response of heart rate to surgical incision was used as an indicator of pain in intraoperative period while the postanesthesia consumption of analgesics and the pediatric pain scores were used for the efficacy of ESP block for postoperative analgesia.
Different adjuvants were used with ESP block to densify and endure its intraoperative and postoperative analgesic function. One these adjuvants were Magnesium sulfate that had been used in perioperative pain management and in suppressing somatic, endocrine and autonomic reflexes induced by noxious stimuli.
Dexamethasone which is a long acting highly potent anti-inflammatory glucocorticoid was also heavily studied as adjuvant in regional anesthesia techniques to improve the anesthetic and the analgesic effect of the local anesthesia and prolong its effect.
Our study was carried out on 60 pediatric patients underwent inguinal hernia surgery under general surgery and received erector spinae plane block either with local anesthetic alone or with magnesium sulfate or dexamethasone as adjuvants.
Patients were randomly divided in to three groups by computer generated randomization, group A, group B and group C:
• group A (20 patients): 0.5 ml/kg Bupivacaine 0.25% (for each 1ml bupivacaine 0.5% diluted by 1ml normal saline).
• group B (20 patients): 0.5ml/kg mixture of 0.25% bupivacaine and 10% magnesium sulfate in ratio 1:1.
• group C (20 patients): 0.5 ml/kg mixture of 0.25% bupivacaine and Dexamethasone 0.2mg/kg diluted in normal saline.
The efficacy of the block was assessed intraoperative by changes of arterial blood pressure and heart rate, if there was increase by more than 20% of one of them or both at any time after start of surgery increment dose of 1µ/kg Fentanyl Intravenous was to be given.
Postoperative assessment by Children’s hospital eastern Ontario pain scale (CHEOPS).if the scale was equal to or more than 5 at 1 hour, 2, 4, 6, 8, 16 and 24hours intervals postoperative a dose of 10mg/kg of paracetamol per oral was given as rescue analgesia.