الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Upper abdominal surgeries are frequently associated with post-operative complications including pain, which is considered one of the most important concerns to the anaesthesiologists. Pain experience is one of the side effects of any surgical procedure that has its own pathophysiology and should be treated promptly.
Post-operative pain assessment is not limited to the evaluation of the pain characteristics but should also include the efficacy of the analgesic interventions used. The excessive or irrational use of analgesics with the objective of easing post-operative pain can also be deleterious to the patient. Also, the intensity of acute post-operative pain appears to be associated with long-term pain-related outcomes as patients with higher pain scores within the first month after surgery have a higher chance of developing post-operative persistent pain. So, careful assessment is indicated to appropriately evaluate and treat post-operative pain.
Inadequate pain relief, apart from being unethical, may result in increased morbidity and mortality. Opioid-sparing, balanced analgesia provides enhanced pain relief and faster recovery compared with opioids or local anaesthetics alone.
Preemptive analgesia is a starting point in effective peri-operative analgesia. It prevents establishment of the altered sensory processing that amplifies post-operative pain. The treatment should cover the entire duration of high-intensity noxious stimulation that can lead to establishment of central and peripheral sensitization caused by incisional or inflammatory injuries.
The current study was carried out in Alexandria Main University Hospital (AMUH) on 40 patients planned for elective abdominal surgeries with upper midline incision. The study aimed to evaluate the efficacy of preemptive US guided RSB for post-operative analgesia in upper abdominal surgeries.
During this study, patients were equally, and randomly divided into two groups: group I (GA); patients received standardized general anaesthesia alone, and group II (RSB) patients received general anaesthesia combined with bilateral ultrasound guided rectus sheath block prior to surgical incision.
In the current study, there was no significant statistical difference regarding patients’ demographic data; Age, gender, weight, and height. ASA classification of patients in both groups had no significant difference. Also, duration of surgery in both groups had no significant difference.
Peri-operative vital signs monitoring included changes in heart rate, MABP, SpO2, and respiratory rate. Heart rate, MABP, and SpO2 monitoring revealed insignificant difference in both groups throughout the peri-operative period. Regarding respiratory rate changes there was a significant increase in GA group compared to RSB group in zero and 4 hours post-operatively, while there was an insignificant difference in the other periods.
Post-operative pain assessment was assessed using VASR, VASM, time to first rescue analgesia, duration of analgesia, total dose of opioids used in the first 24 hours post-operatively, and ambulation time. Statistical analysis for VASR values showed a significant decrease in RSB group at zero, 1, 2, 3, 4, 8, 12, and 16 hours post-operatively compared to GA group. Similarly, statistical analysis for VASM values showed a significant decrease in RSB group at zero, 1, 2, 3, 4, 8, 12, 16 and 20 hours post-operatively compared to GA group.
Summary 74
Time to first rescue analgesia, and duration of analgesia showed a significant increase in RSB group compared to GA group proving better post-operative analgesic efficacy for US guided RSB. Also, statistical analysis for total dose of opioids used in the first 24 hours post-operatively, and ambulation time showed a significant lower values in RSB group compared to GA group.
Incidence of complications was recorded including LA toxicity, PONV, and hemodynamic instability in both groups. Signs of LA toxicity didn’t occur in any patient during the current study. PONV, and attacks of tachycardia was significantly lower in RSB group compared to GA group.