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The intervention referred to as **Adjuvants + Anesthesia-Ain Shams University-postoperative pain** describes a clinical research protocol led by Ain Shams University evaluating the efficacy of anesthetic adjuvants in regional anesthesia. Specifically, the study investigates the addition of **ketamine** or **neostigmine** to **bupivacaine** for ultrasound-guided Serratus Anterior Plane Block (SAPB) in patients undergoing modified radical mastectomy. Ketamine acts as a non-competitive NMDA receptor antagonist, providing both systemic and regional analgesic effects. Neostigmine, an acetylcholinesterase inhibitor, is utilized to increase local acetylcholine concentrations, which may enhance and prolong the sensory block provided by local anesthetics like bupivacaine. The primary goal of this combination therapy is to reduce 24-hour postoperative opioid consumption (specifically nalbuphine) and extend the duration of effective analgesia.
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