الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Postoperative pain is one of the most important issues in major abdominal surgeries. More than 80% of patients who undergo surgical procedures experience acute postoperative pain. Such pain if not properly managed can induce shallow breathing, atelectasis, retention of secretions and lack of cooperation in physiotherapy with subsequent development of postoperative complication and delayed recovery. The use of epidural analgesia in management of postoperative pain remains an important topic. Several studies reported the beneficial outcomes of epidural analgesia and encouraged the use of epidural analgesia over other analgesic modalities. Quadratus Lumborum block is relatively new interfacial plane block that proved to be effective in certain surgeries including abdominal surgeries. The aim of the work This study aimed to compare analgesic profile of bilateral Quadratus Lumborum block to epidural block after major abdominal surgeries in terms of time to first request of analgesic, postoperative pain VAS score at rest, during cough and sitting, and the total postoperative rescue analgesic consumption, perioperative hemodynamics, and postoperative adverse events. Materials and Methods: The study subjects were randomly assigned to one of two equal groups (epidural group and Quadratus Lumborum group) as following: Epidural group (E) (40): patients received epidural analgesia using 1.5 ml of .25% bupivacaine for each space + 50µ fentanyl. Quadratus lumborum group(Q) (40): patients received ultrasound guided lateral Quadratus Lumborum block on each side using 15 ml 0.25% bupivacaine+25µ fentanyl Dissertation Abstract Central library Results: Epidural anesthesia receiving group has statistically significantly higher mean time to request the first rescue analgesic, lower pain VAS scores at rest, on movement , and during cough during the first 6 postoperative hours, and lower total morphine consumption during the first postoperative 24 hours. Perioperative mean arterial blood pressure changes showed statistically significant intraoperative reduction in the epidural group from 30 to 120 minutes. Otherwise no statistically significant differences were detected between both groups at all readings assessed. There were no statistically significant differences in the perioperative mean heart rate between studied groups except at the intraoperative period from 45 to 90 minutes where the HR in the E group was statistically significantly lower than in the Q group. The incidence of postoperative adverse effects was comparable among the two groups. Conclusion: Epidural block provided superior analgesia to QLB as evidenced by lower morphine consumption and pain VAS scores, and longer duration of analgesia with comparable morphine related side effects profile, but with more hypotension.