الفهرس | Only 14 pages are availabe for public view |
Abstract Unceasing efforts have been tried to control the postoperative pain effectively. Multimodal techniques are consisted of combinations of opioids (either systemically or neuraxially), nonsteroidal anti-inflammatroy drugs, paracetamol, regional and peripheral nerve blocks are currently used for pain control after surgery. There are concerns with regard for the potential of systemically administered opioids to cause nausea, vomiting, drowsiness and respiratory depression Furthermore; epidural analgesia can develop hypotension, vomiting, urine retention in addition to serious complications such as epidural abscess, meningitis, vertebral canal hematoma, spinal cord ischemia and paraplegia. Recently, peripheral nerve blocks have been implemented to alleviate the problems above in addition to controlling the postoperative pain effectively. The use of ultrasound-guided nerve blocks offers the advantage of direct visualization of the needle and the anatomical structures. Therefore, one can see real-time images during the procedure and inject drugs more accurately and rapidly into the target site than with nerve stimulator or blindly blocking peripheral nerves. So, this enhances the safety and efficacy of the procedure. Transversus abdominis plane (TAP) block is an effective method of blocking the sensory afferents supplying the anterior abdominal wall. There are two types of TAP block (posterior and subcostal). Posterior TAP block has been shown to provide analgesia after lower abdominal surgery but Subcostal TAP block has been reported to provide analgesia for incisions extending above the umbilicus. Rectus sheath block is performed by administration of local anesthetic into the space between the rectus muscle and posterior rectus sheath to block. |