الفهرس 
PATHOPHYSIOLOGY OF PAINOnly 14 pages are availabe for public view
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Abstract
Postoperative pain is a potent cause of adverse effects in many organ systems thus anterior abdominal wall analgesia after abdominal surgery may assist in improving postoperative outcome.
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. Until recently, there has been renewed interest in abdominal field blocks and the quest for a single injection providing widespread analgesia has lead to the rapid popularity of the Transversus Abdominis Plane (TAP) block. The description of a landmark technique for performing a TAP block advocated a single entry point, the triangle of Petit, to access a number of abdominal wall nerves hence providing multi-dermatome analgesia.
This randomized controlled trial is the first one aimed to explore the effectiveness of a novel pain control technique known by Transversus Abdominis Plane block (TAP) in comparison to the conventional pain block by systemic analgesics, and the already established neuro-axial block (epidural analgesia).
Regarding Postoperative hemodynamic status assessment, hemodynamic stability was seen among the TAP block with neither hypertension nor hypotension, moreover, heart rate assessment didn’t any abnormal readings in comparison to the epidural group which showed hypotension within the first 10 minutes after starting the block.
Reduction in the postoperative pain scores (VAS at rest and knee flexion), was the main factor realized to be responsible for maintenance of the cardiovascular stability, together with reduction in the incidence and severity sedation scores. Thus the total opioids requirements the least among the TAP block in comparison to the other two groups especially the control one.
from this we concluded that incidence of postoperative complication as postoperative complications as, (nausea, vomiting, and pruritis), which resulted due to systemic use of opioids were mostly among the control group rather than the other two groups. The reason for this could be that the requirements of pethidine among the control group were higher than that among the other two groups.
Considering motor block in the current study, the epidural group showed higher percentage of motor block as regard the complete motor block, and the partial degree block that’s because of its mode of action as a neuro-axial analgesia acting upon the motor and the sensory supply of the lower half of the body. While incidence of complete motor block or partial block didn’t occur among the TAP group. The reason for this was because the total doses of systemic used opioids were not enough to drive the candidate to stay long in bed (loss the ability to maintain posture) like what happened with the control group.
Moreover the nature of the block itself dose not involve motor supply of the lower limb ,only affecting the tone of the abdominal muscle as the presence of “Flank Bulge” was considered to be a sign of successful TAP block.
Finally, use of the TAP block proved to be a simple and safe procedure in providing effective reliable analgesia, together with reduction of postoperative pain scores, both at rest, at movement, and postoperative opioid requirements together with their systemic side effects.