الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Total abdominal hysterectomy (TAH) is a major surgical procedure associated with a significant postoperative pain and morbidity. Epidural analgesia has been widely used as a method of choice for management of postoperative pain in patients following TAH except in those with raised intracranial tension, coagulopathy, patient refusal, local sepsis, inability to maintain stillness during needle puncture, and limited expertise.
The level of pain associated with hysterectomy as well as the length of the period of convalescence depends on the surgical approach. Open abdominal hysterectomy is considered as a major surgery and is associated with a medium to high pain level.
The use of IV LA infusions for postoperative pain control dates back to the 1940s when IV procaine was reported to provide analgesia for burns, abdominal surgery and mastectomy. The use of parenteral lidocaine for postoperative pain first was reported in 1961 in patients undergoing cholecystectomy, appendectomy and pelvic laparotomies with reported dramatic reductions in pain and opioid use. More recently, studies in radical prostatectomy and colectomy suggest systemic lidocaine for pain relief.
Intravenous lidocaine promotes significant relief of (Postoperative pain) P.O.P, decreased consumption of opioids, early recovery of bowel function, and decreased production of interleukins. Interleukin-6 (IL-6), a molecule of approximately 21,000 Daltons, is a cytokine detected early in tissue injury with increased levels more with degree of tissue injury during surgery rather than duration of the procedure. It has been considered a predictor of the severity of the surgical trauma.
The aim of this work was to compare between intravenous and epidural lidocaine in patients undergoing total abdominal hysterectomy for benign gynaeological disorders as regards post-operative pain, total analgesic consumption, haemodynamic parameters and postoperative side effects.
The present study was done on 50 patients ASA physical status I and II, of female patients 20-50 years old, scheduled for total abdominal hysterectomy for benign gynaeological disorders under general anaesthesia. Patients were randomly categorized into two equal groups:
• group I: Patients received 1.5 mg/Kg lidocaine before induction (maximum 100 mg) 2 mg/kg/hr during surgical procedure and 1 mg/kg/hr postoperative for 24 hours.
• group II: Patients received lumbar epidural analgesia with lidocaine.
Haemodynamic changes were assessed by frequent monitoring and recording of the heart rate, blood pressure. Assessment of pain both at rest (static) and during coughing (dynamic) was assessed using a visual analogue scale (VAS).