الفهرس 
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Abstract
In this study we had compared the effect of continuous unilateral Subcostal TAP catheter infusion and thoracic Epidural infusion on postoperative analgesia after major upper abdominal surgeries. We made a comparison between two groups of patients, each group consists of forty-two patients scheduled for major upper abdominal surgeries. Eighty-four patients were randomized for elective major upper abdominal surgeries. They were randomly allocated to 2 equal groups, 42 patients each. First group (group E), Patients had received preoperative bolus epidural (bupivacaine and magnesium sulphate) and postoperative bupivacaine and magnesium sulphate infusion. Second group (group S), patients received preoperative US guided bolus subcostal TAP block (same drugs and doses of Epidural group) and postoperative bupivacaine and magnesium sulphate infusion (same dose as epidural group). The study was registered at ClinicalTrials.gov (NCT03949452). We have started preoperatively - for achievement of pre-emptive analgesia – by equal bolus doses of local anesthetic in both groups. Then examination of sensory block in both groups was done to ensure effectiveness of both blocks and exclude failed blocks. A TAP catheter was inserted by the surgeon during wound closure and an equal local anesthetic infusion run postoperatively to both groups. A standard postoperative analgesic regimen consisting of 1 gm. paracetamol/ 6 hours for 72 hours was given in both groups. Intravenous morphine was given if intolerable pain exists. Morphine consumption, pain and postoperative analgesia were assessed by visual analogue scale pain score. Finally, we have found that Subcostal TAP catheter when combined with magnesium sulphate as adjuvant to local anesthesia can provide adequete static and dynamic analgesia, when compared to epidural analgesia, where the incision was limited to at or above the T10 dermatome. Subcostal TAP catheters analgesia may be an effective alternative to epidural catheter analgesia for providing postoperative analgesia in patients undergoing major upper abdominal surgeries. In conclusion, we have found that Subcostal TAP catheter infusion analgesia when combined with magnesium sulphate as adjuvant to local anesthetic provide adequate analgesia when compared to epidural analgesia in patients undergoing major upper abdominal surgeries but it avoid major drawbacks of epidural analgesia as haemodynamic instability, affection of sensory and motor functions of the lower limbs. Hence, subcostal TAP catheters may be an effective alternative to epidural catheter for providing postoperative analgesia after major upper abdominal surgeries.