الفهرس 
P ATHOPHYSIOLOGY OF P AINOnly 14 pages are availabe for public view
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Abstract
Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and incrase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs.
The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses.
In order to blunt the autonomic and somatic reflex responses to pain and to enhance subsequent restoration of the function of different body-organs as breathing, coughing, and moving easily, together with resumption of oral feeding, and early hospital discharge, Many studies have been carried out trying to find a solution for these dilemma thus different pain modalities as local infiltration of the surgical field, systemic analgesia (narcotics and non-narcotics), neuro-axial blocks, and nerve blocks shined out, however each has shown its side effect which limits its use to specific cases.
Abdominal field blocks have been extensively used for a variety of surgical procedures for many years. They are simple to perform and have a good safety profile.
This study assessed the postoperative analgesic efficacy of oblique sub costal transversus abdominis plane (TAP) block compared to local wound infiltration after hepatectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS).
The study was conducted on 60 randomly chosen patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I or II and III scheduled for hepatectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each:
TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by oblique subcostal approach under ultrasound guidance.
Local wound infiltration: received general anesthesia and with 0.25% bupivacaine 40 ml at surgical site.
The two groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed.
The results of the study revealed that the Patients who received TAP block had significantly lower pain scores for 12 h after operation and decreased total need of analgesic in first 24 h post operative compared with patients who received wound infiltration.