الفهرس 
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Abstract
Our study was conducted on patients in surgical department and postoperative anesthesia care unit (PACU) in Assuit University, Egypt, after obtaining Hospital Ethical Committee approval; it was prospectively registered at “www. clinicaltrial.gov”. Written informed consent from 44 ASA I-II patients aged 18-60 years, with a body mass index (BMI) of 18-35 kg/m2 and scheduled for laparoscopic cholecystectomy was obtained. Excluded from the study patients with known allergy to the study drugs, skin infection at site of needle puncture, chronic pain syndromes, coagulopathy, prolonged opioid medication and patients who received any analgesics 24hr before surgery. Our aim was to compare the analgesic efficacy of ultrasound guided erector spinae block with port site infiltration in laparoscopic cholecystectomy. The participating patients were randomly allocated using computer generated randomizer program (http://www. randomizer. org) into one of 2 groups. group (A): 22 patients (study group): Erector spinae plane block group group (B): 22 patients (control group): Local infiltration group The following parameters were recorded intraoperatively every 5 min: HR, SBP, DBP, and MAP for first 30 min and every 15 min thereafter till the end of surgery. Postoperatively, Numerical rate scale (NRS) for pain at rest and when coughing was assessed serially at 1, 2, 4, 8, 16 and 24 h after surgery. Rescue analgesics (nalbuphine 0.05 mg/kg bolus as 1st line rescue analgesic and ketorolac 30 mg as 2nd line rescue analgesic) were administered when NRS ≥4 or when the patient complains of pain. Time for first analgesic request and NRS at first analgesic request was recorded. Total doses of rescue analgesics required in the first 24 hr. were recorded. Shoulder pain and presence of postoperative nausea and vomiting were noted. We found that the study group (ESPB group) showed satisfactory pain relief without serious side effects as showed by significant prolonged time of first analgesic request, significant decrease in total amount of nalbuphine consumption as 1st line rescue analgesic, significant decrease in number of patients who needed ketorolac as 2nd line rescue analgesic, significant decrease paracetamol consumption and significant decrease in numerical rate score at rest and when coughing for 24 hours postoperative with significant better hemodynamic profile compared to the control group (port site infiltration group) and significant minimal side effects were experienced manifested by shoulder pain and nausea and vomiting. The first analgesic request was significantly delayed in the study group to 6.23 ± 1.51 hours compared to the control group where the first analgesic request was 1 hour. The total amount of nalbuphine consumption was 8.27 ± 1.12mg as 1st line rescue analgesic request in the study group while in the control group the amount of nalbuphine consumption was 15.92 ± 2.11mg. 10 patients in the study group needed ketorolac as 2nd line rescue analgesic while all patients in the control group needed ketorolac. The total amount of paracetamol consumption was 1.59 ± 0.50 gm in the study group while in the control group, it was 2.77 ± 0.43 gm. Also there was a significant decrease in the numerical rate score at rest and when coughing along 24 hours postoperative in the study group when compared to the control group. No patients experienced shoulder pain and only 5 patients had nausea and vomiting while in the control group, 14 patients experienced shoulder pain and all of them had nausea and vomiting. As regarding hemodynamics (Heart rate and Arterial blood pressure), they were significantly lower among the study group when compared to the control group. In conclusion from the findings of this study erector spinae plane block (ESPB) was superior to port site infiltration regarding, decrease in analgesic consumption and prolongation in time of postoperative rescue analgesia in patients undergoing laparoscopic cholecystectomy.