الفهرس 
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Abstract
Laparoscopic cholecystectomy (LC) is the most common intraabdominal surgical procedure globally. Despite improvements in
anesthesia and surgery, postoperative pain is still a crucial problem after
LC. Perioperative pain management goals are to alleviate suffering,
obtain early mobilization and rapid discharge, and improve patient
satisfaction.
While there are now many regional anesthetic techniques for use in
thoracic and abdominal procedures, very few of these techniques are
appropriate for postoperative analgesia in laparoscopic cholecystectomy
(LC). LC leads to somatic pain from the supraumbilical abdominal area
and visceral pain due to pneumoperitoneum and surgical manipulation.
Ultrasound-Guided Erector Spinae Plane block (US-ESP), described
by Forero et al. in 2016 has gained popularity. This new regional
technique provides analgesia via its effects on the ventral rami and dorsal
rami of the spinal nerves, depending on the level of the injection site. As
the erector spinae fascia extends between the nuchal fascia cranially and
sacrum caudally, the injected local anesthetic agent spreads over several
levels.
The External oblique intercostal plane (EOI) block is a recently
described technique for upper midline and lateral abdominal wall
analgesia. Elsharkawy et al. demonstrated the potential mechanism of this
technique with a cadaveric study reporting consistent staining of both
lateral and anterior branches of intercostal nerves T7-T10. So, this study
aimed to evaluate the analgesic effect of bilateral erector spinae plane
block versus bilateral external oblique intercostal plane block in patients
undergoing Laparoscopic Cholecystectomy.
To elucidate our aim a prospective randomized double-blind study
conducted on 93 of patients were randomized into three groups using a
closed envelope technique in sequentially numbered opaque envelopes
that was opened by an anesthesiologist not involved in the study. This
study was conducted in National Liver Institute, Menoufia University
during the period time from April 2023 to December 2023.
All patients were subjected to the following preoperative
surveillance included hematological screening (hematocrit level, serum
electrolytes, and blood grouping), biochemical liver and renal tests,
standard coagulation studies e.g., prothrombin time-international
normalized ratio (PT-INR). In addition, electrocardiography and chest Xray were ordered if indicated. Intraoperative management, premedication,
general anesthesia induction, and maintenance were the same for all
patients. Standard monitoring procedures include pulse oximetry,
electrocardiography, and noninvasive arterial pressure prior to anesthetic
induction. Postoperative measurements include time for the first request
for rescue analgesia (when NRS is 4 or more), Numerical Rating Scale (NRS score) and hemodynamics: (HR and MAP).