الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 92 |  |  |
| | | from | 92 | | |
Abstract
Postoperative pain is still undertreated and a lot of patients continue to suffer after surgery. Unrelieved postoperative pain has several negative impacts on the patient’s health as it increases patient’s anxiety, heart rate, blood pressure, catecholamine and cortisone release. It also impairs respiratory function, gastrointestinal motility and carbohydrate and protein metabolisms. Furthermore, it may persist after wound healing and transform to chronic pain. A great effort is still needed to enhance postoperative pain management and reduce its consequences on patient’s life.
Laparoscopic cholecystectomy, despite being a much less invasive procedure than open cholecystectomy is still associated with significant levels of postoperative pain, which prolongs the hospital stay and increases readmission rates. The postoperative pain is the worst in the first 24 hours after surgery, with visceral pain being the predominant pain, followed by somatic pain. Furthermore, patients with higher visceral pain intensity showed higher risk of a chronic pain development after LC. Therefore, a number of different anaesthetic techniques have been developed to complement the benefit of minimally invasive surgical approach on pain relief and decrease postoperative analgesic requirements.
The aim of this study was to compare the efficacy of ultrasound guided subcostal transversus abdominis (STA) and erector spinae plane block on the intensity of postoperative pain.
Our study was carried out on 50 patients ASA I or II admitted to Alexandria main university Hospital and scheduled for elective laparoscopic cholecystectomy. Patients will be randomized by sealed envelope technique into two equal groups (25 patients each): group (1): 25 patients will receive ultrasound-guided subcostal transversus abdominis (STA) block. group (2): 25 patients will receive ultrasound-guided Erector spinae plane block. The day before surgery, all patients were informed with the anaesthetic techniques and trained to use the visual analogue scale (VAS). Standardized general anesthesia will then be induced in both groups. Pre-oxygenation was done with 100% oxygen for 3 min. Induction will be done with propofol 2 mg/kg intravenous (IV), fentanyl 2 μg/kg IV and atracurium 0.5 mg/kg IV to facilitate endotracheal intubation. Then volume control mechanical ventilation was then instituted, VT 6-8ml/kg and was adjusted according to PET CO2. Anesthesia was maintained with 1-2% Isoflurane in 50% O2 and air. Muscle relaxation will be maintained with atracurium 0.1 mg/kg IV guided by nerve stimulator. All patients received dexamethasone (8 mg) and ondansetron (4 mg) intravenously. Regional anesthetic technique after induction. STA: group I Subcostal TAP blocks will be performed under the guidance of ultrasound. An in-plane image was obtained and the needle was inserted through the rectus muscle 2–3 cm medial to the probe. Once the tip of the needle was visualized in the plane, 20 ml 0.25% bupivacaine was administered incrementally. The drug was injected along the oblique subcostal line.
ESP block: group II On the lateral position, under strict aseptic technique Ultrasound probe was applied in a longitudinal orientation 3 cm lateral to the T7 spinous process. Three muscles will be identified superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major and erector spinae. The needle was inserted in-plane in cephalic-to caudal direction until the tip contacted the T7 transverse process below the erector spinae muscle. 20 ml 0.25% bupivacaine was administered.
At the end of surgery, neuromuscular blockade will be reversed with injection of neostigmine (0.04 mg/ kg) with atropine (0.01mg/ kg) and the patient will be extubated and transferred to the postoperative care unit.
Postoperative pain assessment using the visual analog scale (VAS) was assessed in the ward for the first 24 hours post operatively and was recorded at 30 min, 2hrs, 6hrs, 12hrs, 18hrs and 24hrs as well as the time of the first dose required by the patient, the total dose of nalbuphine required and occurrence of postoperative nausea and vomiting.
The results were as follows:
No statistically significant differences were present between the two groups regarding demographic data (age and sex).
The comparison between the two studied groups showed that there was no significant difference in the heart rate between the two groups.
Comparing MABP revealed that there was no significant difference between both groups.
Comparing VAS in the two groups showed that, it was significantly lower in group II than group I at all measured times except at 6hrs and 12hrs.
The total amount of postoperative IV nalbuphine consumption was significantly higher in group I compared to group II (p<0.001).
Comparing time to first requirement for IV nalbuphine by the patient showed statistically significant difference between the two groups (P0.037).
There was no significant difference between the two groups as regards the incidence of PONV.