الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Inadequately managed pain can lead to adverse physical and psychological patients’ outcomes, increased patient stress and dissatisfaction, development of chronic pain and depression in addition to other cardiopulmonary complications and slower recovery. TAP block is one of the most efficacious and simple regional technique for abdominal surgeries, with the advantage of lacking the sympathetic effects of neuraxial anaesthesia. Use of ultrasound guidance for regional anaesthesia has led to a surge in the number of newly described interfascial plane blocks in which local anaesthetics are administered to achieve surgical anaesthesia or postoperative analgesia. The closer to the spine the LA is injected, the better will be the efficacy in TAP block, which may be related to the spread of LA to the paravertebral space. Therefor; QL blocks resulted in a wider sensory blockade, more visceral blockade and better analgesia compared to TAP block when performed using the similar volume of local anaesthetic.
The aim of this study is to evaluate the effect of pre-operative USG trans-muscular QLB versus USG anterior oblique subcostal TAP block on acute postoperative pain intensity and opioid consumption.
This study was carried out on 52 patients, (ASA I, II) who underwent laparoscopic cholecystectomy and were randomly assigned to one of two equal groups (twenty six patients in each group), via the sealed envelope technique. group (I) received US-guided TAP block while group (II) received US-guided QL block.
On arrival to the operative theatre a peripheral venous catheter was inserted in all patients, multichannel monitor was attached to the patient to display ECG (lead II), heart rate (beats/min), non-invasive mean arterial blood pressure (mmHg) and oxygen saturation (SpO2).
After premedication with IV midazolam (0.05mg/kg) and fentanyl (0.5μg/kg), patients in group (I) received TAP block and patients in group (II) received QLB by using 20 ml bupivacaine 0.25 % at each side under the guidenence of US.
General anaesthesia was induced with intravenous fentanyl 1 μg/kg, propofol 2.5mg/kg, and cisatracurium 0.15 mg/kg. Anaesthesia was maintained with isoflurane 1.2 – 1.5% and oxygen/air mixture. Cisatracurium 0.03 mg/kg was given to maintain the train of four (TOF) count at 2 using nerve stimulator. Ventilation was maintained at a tidal volume of 6ml/kg and a rate to adjust the end-tidal carbon dioxide at (35 mmHg). At the end of surgery, anaesthesia was discontinued and residual neuromuscular block was reversed by atropine 0.01 mg/kg and neostigmine 0.04 mg/kg .The trachea was extubated and the patients were transferred to the postoperative anaesthesia care unit (PACU) for the next 24 hours.
Postoperative pain was controlled using IV morphine PCA at concentration of 1 mg/ml using 1 ml patient activated dose with lock out time 6 min and a 10 ml maximum dose/4 hr for 24 hr. Patients also received IV 30 mg ketorolac /6hours for the first 24 hours.
Postoperative pain assessment using VAS was recorded every hour for the first 4 hours and every 4 hours for the rest of the 24 postoperative hours and total amount of IV morphine was recorded at the end of the 24 postoperative hours as well as the time of the first dose required by the patient. Patient satisfaction score was evaluated by the patient satisfaction questionnaire which assessed the satisfaction with information and pain management provided by the anaesthetist before patients were discharged home.