الفهرس 
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Abstract
The Transversus Abdominis Plane (TAP) Block is a local anesthetic block used to provide analgesia to the anterior and lateral abdominal wall. Rafi et al (2001) and McDonnell et al (2004) were the first to describe this novel abdominal field block. They described an anatomical landmark technique and provided evidence of blockade to the mid/lower thoracic and upper lumbar spinal nerves as they travelled in the fascial plane between the transversus abdominis and internal oblique muscles. Hebbard et al (2007) have subsequently described an ultrasound-guided approach to the TAP block.
TAP block is a new regional anesthesia technique that provides analgesia following abdominal surgery. It became increasingly popular worldwide because of its relative simplicity and efficacy. The technique involves a single large bolus injection of local anesthetic into the TAP, an anatomical space between the internal oblique and transversus abdominis muscles and provides highly effective postoperative analgesia in the first 24–48 hours or insersion of catheter and subsequent injections. As a component of a multimodal analgesic regimen. TAP block reduces IV morphine requirements by more than 70% and consequently reduces opioid-mediated side effects.
In this study, we did an ultrasound guided sub costal transversus abdominis plane block using a high frequency ultrasound ,with insertion of a catheter in the plane and injection of local anesthetics at 8 hours interval for 3 days for analgesia of the upper abdominal surgeries like open cholecystectomy, pyeloplasty, nephrectomy,etc.
48 patients who were undergoing upper abdominal incisions operations, were divided into two groups, comparing the intra-operative and postoperative analgesic effects of both methods using the intra-operative hemodynamics, postoperative hemodynamics, visual analogue pain score, patient satisfaction, and the total amount of opioid ”morphine” used throughout the 1st 72 hours postoperative.
This study showed that there is no difference between the sub costal transversus abdominis plane block and thoracic epidural as post-operative pain scores, patient satisfaction and hemodynamic changes and can be used as alternative to thoracic epidural.
Conclusion:
- Ultrasound guided sub costal transversus abdominis plane block is a new regional technique that provides analgesia following upper abdominal surgery, also it reduces IV morphine requirements and consequently reduces opioid-mediated side effects. ,it is convenient for unilateral analgesia and when epidural analgesia is contraindicated or when there is a lack of facilities for epidural analgesia, however this study showed that it possessed comparable postoperative analgesia as the epidural one.