الفهرس 
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Abstract
Adequate post operative analgesia is one of the most important issues following surgery. Pain control decreases the post operative morbidity and facilitates improved surgical outcomes. After laparoscopic cholecystectomy, numerous modalities have been used to alleviate pain which include non steroidal anti inflammatory drugs, opioids, local anesthetic infiltration, thoracic epidural block and multi modal analgesia.
Transversus abdominis plane (TAP) block inhibits abdominal neural afferents by introducing LA into the neuro-fascial plane between the internal oblique and transversus abdominis muscles. The TAP block is now established as an important technique for reduction of post operative pain following abdominal surgery.
The study population included 60 patients who were randomized into two groups: group A: TAP block with Bupivacaine 0.25% 20 ml. group B: TAP block with Bupivacaine 0.25% 18 ml +Hyaluronidase 750 I.U (dissolved in 2 ml Bupivacaine) ultrasound guided transversus abdominis plane block on each side of abdominal wall in elective laparoscopic cholecystectomy surgeries performed under general anesthesia.
The mean age of the patients was 41±8.3 in bupivacaine and hyaluronidase group and most of them were females (56.7%) and according to ASA state most of them were ASA I (83.3%). On the other hand, in bupivacaine only group the mean age of the patients was 38.8±8.2 in bupivacaine and hyaluronidase group and most of them were females (73.3%) and according to ASA state most of them were ASA I (83.3%).
Regarding the total analgesic amount requirements, this study showed that there was no statistically significant difference between both groups regarding the dose of analgesia after 2, 4, 6, 12, 18 and 24 of the operation in addition to the total amount of analgesia. However, the average of total amount of analgesia requested by patients in bupivacaine and hyaluronidase group was 6.3±6.9 still lower than that requested by patients in bupivacaine only group that was 9.2±8.2.
There was a statistically significant longer mean time to 1st request of analgesia being 10.2±3.1 hours in bupivacaine and hyaluronidase group than bupivacaine only group being 5.2±1.9 hours. According to the NSR pain score, there was no statistically significant difference between bupivacaine and hyaluronidase group and bupivacaine only group after 2, 4, 6, 12, 18 and 24 of the operation
Regarding the hemodynamics of the patients under the study, there was a statistically significant higher systolic and diastolic blood pressure in bupivacaine and hyaluronidase group than bupivacaine only group after 2, 4, 6, 12, 18 and 24 hours of the operation but the percentage of increase (from 2 hours to 24 hours) was significantly higher in bupivacaine only group than bupivacaine and hyaluronidase group.
As regards to the heart rate, there was a statistically significant higher hart rate in bupivacaine and hyaluronidase group than bupivacaine only group after 2, 4, 6, 12, 18 and 24 hours of the operation but the percentage of increase (from 2 hours to 24 hours) was significantly higher in bupivacaine only group than bupivacaine and hyaluronidase group.
There was a statistically significant lower oxygen saturation in bupivacaine and hyaluronidase group than bupivacaine only group after 12 and 18 of the operation but the percentage of increase (from 2 hours to 24 hours) was didn’t differ significantly in both groups.
There was no statistically significant difference between both groups regarding the post operative side effects. In bupivacaine and hyaluronidase group only 6 patients (20%) complained of nausea and 2 patients (6.7 %) had hypotension. On the other hand, in bupivacaine only group 8 patients (26.7 %) had nausea and 6 patients (20%) had hypotension.