the use of fentanyl with bupivacaine versus tramadol with bupivacaine in spinal anaesthesia for cesarean section

spinal anesthesia has many advantages for anaesthesia for lower segment cesarean section and it is commonly used for it nowadays. The patient is awake and therefore her airway is safe. Babies born to mothers having spinal (or epidural) anaesthesia may be more alert and less sedated as they have not received any general anaesthestic agents through the placental circulation.Bupivacaine is the most frequently used local anesthetic for preoperative and postoperative pain relief in cesarean section. Bupivacaine is an amide local anesthetic with a prolonged duration of blockIt has become a popular practice to add opioids to spinal solutions to enhance and prolong intra-operative and post-operative analgesia.Morphine and fentanyl are the opioids most often used for this purpose, but there is not a general consensus about the benefits of the various regimens, and the incidence of side effects with different opioids and doses is controversial.Tramadol is a synthetic 4-phenyl-piperidine analogue of codeine. It considered to be a weak opioid, the adverse effect profile of tramadol appeared to be atypical of a pure opioid agonist.The aim of this study is to compare between the use of Fentanyl with Bupivacaine and the use of Tramadol with Bupivacaine in the efficacy, duration of anesthesia and postoperative analgesia and side effects when used in spinal anesthesia in cesarean Section.