Nowadays lower segment cesarean sections are preferably carried out under regional anesthesia due to multiple advantages.

Local infiltration of lidocaine or any other anesthetic is used before lumber puncture in many centers to reduce needle stick pain.

EMLA (eutectic mixture of local anesthetic) cream is the combination of lidocaine and prilocaine which have been effectively used in few studies to reduce needle prick pain.

We would like to see which analgesic pretreatment is superior in terms of reducing pain of spinal needle insertion and have better maternal satisfaction levels.

OBJECTIVES: To compare the pain reduction and maternal satisfaction levels of two analgesic pretreatment modalities on pain reduction of spinal needle insertion i.e. 2% lidocaine infiltration and EMLA in patients undergoing elective LSCS.

Hypothesis: Analgesic pre-treatment with EMLA is superior to local skin infiltration with lidocaine

Inclusion Criteria:

• All adult women undergoing elective LSCS under spinal anesthesia

Exclusion Criteria:

• BMI of more than 35 kg/m2
• Contraindication to spinal anesthesia
• Spinal deformity
• Refusal of regional anesthesia
• Patients with a history of back surgery
• confirmed allergy to local anesthetics
• More than three attempts of needle insertion for inducing spinal anesthesia

Female pregnant patient planned for elective cesarean section under spinal anesthesia