The current study showed that VAS score was not significantly different between the three studied groups at 2, 12 and 24 hours.  While, at 4- and 6-hours VAS were significantly lower among Bupivacaine group than Meloxicam and placebo groups. Also, VAS score was significantly lower in Bupivacaine and Meloxicam groups as compared placebo group at 8 hours. These results were in accordance with the study done by Atashkhoii et al. (2006) who found that Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening, and at 6h after surgery.

Another study by [10] there was no significant difference in VAS for pain at 1-hour post operatively and pethidine consumption concluded that local skin infiltration using Bupivacaine 0.5% was not successful in controlling post-cesarean section somatic pain. The results of their study contradict our study. This contradiction may be due to the difference between the number of patients in both studies and due to different concepts in infiltration of the wound (pre-incision skin infiltration was done). [11] showed that the VAS was significantly lower in the levobupivacaine group compared to the other two groups. This comes parallel to study by [12] reviewed data from 20 studies that together involved 1.150 women who gave birth by CS. They found that women treated with local anaesthetic didn't require as much morphine or other opioid drugs for pain relief after their operation which agree with the results of our study. Likewise, [13] showed that it was a safe and simple technique that provides effective analgesia and reduces Morphine requirements after C.S.

This is in accordance with another study conducted by [14] concluded that pain scores were significantly reduced at 12 h but not 6 h after surgery in the LA group compared with placebo group. At 24 h and 48 h after surgery, the pain sore was lower, but the difference did not meet the common level of significance. A lower rate of post-operative nausea was observed in the LA group. Similarly, Sedek and Kassab, (2015) found that infiltration of the wound with bupivacaine reduced post-operative pain and analgesic requirements which agree with the results of our study. There was a statistical highly significant difference in visual analogue scale values after 30 min, 2h, 4h as comparing group C (control) to group A (Lidocaine) and group B (Bupivacaine). There was no statistically significant difference in visual analogue scale after 6h, 12 h and 24 h comparing group C to group A and group B.

In the current study, Bupivacaine and Meloxicam groups had significantly higher satisfaction than placebo group. These results were corresponding to [15] who found that Mean satisfaction score of patient, surgeons and anesthesiologist were significantly higher in the Group BF and Group RF; as compared to group S. Mean Satisfaction score of patients, surgeon and anesthesiologist in Group BF was also significantly higher than in Group RF. Thus, satisfaction score was Group BF > Group RF > Group S. This finding is also consistent with [16] found that nine patients in the L group (levobupivacaine) and 10 patients in the B group (bupivacaine) experienced excellent satisfaction. Six patients in each group experienced good satisfaction and five patients in each group experienced moderate satisfaction. Finally, two patients in the L group and one patient in the B group reported poor satisfaction. While, in the study conducted by [17] found that the levobupivacaine group significantly showed the highest patient satisfaction rate among the three study groups (Levobupivacaine, Meloxicam, Placebo) with 90.4% (47 patients out of 52).

The present study revealed that there were no statistically significant differences between the studied groups regarding complications and drug side effects. There was decrease in the incidence of local itching, Nausea and vomiting in the three groups. Our results were intimately in accordance with the study of [16] who found no significant complication was observed among Levobupivacaine and bupivacaine groups. [18] found no perioperative complications directly related to the injection of a combination of bupivacaine, epinephrine, and morphine. Another recent study by [17] showed that no significant post-operative complications occurred with any of the three drugs (Levobupivacaine, Meloxicam, Placebo). While Atashkhoii et al. (2006) found that there were significant differences regarding postoperative complications such as nausea, vomiting, pruritus, and respiratory depression and patients who asked for antiemetic between the two groups at the first 24h after surgery. This agrees with the well-known safety profile of bupivacaine that was proved before by a lot of studies as well as that of meloxicam.

No adverse effects are detected from the dose of bupivacaine used in previous studies. This observation is consistent with pharmacokinetic studies in which no ad-verse clinical effects were reported from intraperitoneal bupivacaine. In our study bupivacaine was administered in doses like that of these studies and peak plasma concentrations were much smaller than the generally accepted toxic value of 3 μg/mL [19,20]. The dose of bupivacaine used was 150 mg in 45 mL bupivacaine 0.375%, which is lower than the maximum dose (175 mg) of drug for infiltration anesthesia [21].