الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The cesarean section is the most commonly performed surgery in gynecology and obstetrics in the world, which is a steadily increasing trend. Unsuccessfully conducted analgesia after cesarean section results in considerable suffering in newly delivered mothers, who consequently may be less willing to feed and care for the new-born. To achieve effective analgesia, a multimodal strategy should be used with simultaneously administered painkillers from all three levels of the analgesic ladder in conjunction with specialized peripheral nerve block techniques.
The aim of this study was to evaluate the effectiveness of ultrasound guided Quadratus Lumborum Block in postoperative analgesia and opioid consumption after cesarean section.
This study was carried out on 40 patients ASA I or II with a gestation of at least 37 weeks admitted to Alexandria main university Hospital and scheduled for elective cesarean section. The patients were randomly assigned to one of two equal groups (20 in each group), via the sealed envelope technique. QLB1 group: received spinal anaesthesia and US-guided QLB block while control group received only spinal anaesthesia.
All patients were informed with the anaesthetic techniques and trained to use the visual analogue scale (VAS).
On arrival to the operative theatre a peripheral venous catheter was inserted in all patients, multichannel monitor was attached to the patient to display ECG (lead II), heart rate (beats/min), non-invasive mean arterial blood pressure (mmHg) and oxygen saturation (SpO2).
After premedication with IV Ondansetron 4 mg as antiemetic and ranitidine 150 mg, spinal anesthesia was performed in the sitting position at the L3–4 interspace with 10 mg 0.5% hyper-baric bupivacaine and 25 μg fentanyl using 25 gauge Quincke needle. After wound closure, in the patients allocated to the QLB I group, bilateral ultrasound guided Quadratus Lumborum block I was performed with 20 ml 0.25% bupivacaine for each side.
The patients of both groups were admitted to the ward and received 1 g of paracetamol IV every 8 hour.
Postoperative pain assessment using VAS was recorded at 2h, 4h, 6h, 12 h and 24 h postoperatively and total amount of IV nalbuphine was recorded at the end of the 24 postoperative hours as well as the time of the first dose required by the patient. Patient satisfaction with pain management was evaluated by the anaesthetist before patients were discharged home