الفهرس 
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Abstract
The transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique that provides analgesia to the anterior abdominal wall after lower abdominal surgeries. The anterior abdominal wall components (skin, muscles and parietal peritoneum) are supplied by sensory neurons derived from the anterior rami of spinal nerves T7 to L1. These neurons traverse through the neurofascial plane between the internal oblique and the transversus abdominis muscles. The aim in TAP block is to access these nerves in this neurofascial plane through surface anatomical landmark i.e. “the lumbar triangle of Petit”. This triangle is bounded anteriorly by the external oblique muscle and posteriorly by the latissimus dorsi muscle, whereas the base is formed by the iliac crest. Later on, ultrasound guidance was used in TAP block and offers high success rate with almost no reported complications.
The current study was designed to compare the use of bupivacaine alone or combined with fentanyl or dexmedetomidine as adjuvants to bupivacaine in ultrasound-guided TAP block for lower abdominal surgeries. Ninety adult patients undergoing elective lower abdominal surgeries under general anesthesia were randomly allocated into three groups; group B received TAP block using 25 ml of bupivacaine 0.25% bilaterally (n=30), group F received TAP block using 25 ml of bupivacaine 0.25% + fentanyl 50 μg bilaterally (n=30), and group D received TAP block using 20 ml of bupivacaine 0.25% + dexmedetomidine 50 μg bilaterally (n=30)
The comparison criteria in this study included postoperative pain (evaluated by VAS) as a Primary outcome and opioids consumption (intraoperative fentanyl and postoperative meperedine consumption in 24 hours). Also included hemodynamic stability, use of atropine & ephedrine, time for extubation, sedation score, and occurrence of PONV, or Organ injury, and local complications as secondary outcomes.