الفهرس | Only 14 pages are availabe for public view |
Abstract Pain is an everyday challenge during all surgeries and it is a chief post-operative complication, so pain management is a corner stone in anesthetic practice. CS surgeries are usually associated with acute postoperative pain and restricted mobility. US-guided nerve block is a considered technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Quadratus lumborum block (QLB) was first described by Blanco17. The main advantages of QLB compared to TAP block is the extention of local anesthetic agent beyond the transversus abdominis plane to thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia, prolonged action of injected local anesthetic solution and blocking of visceral pain. Previous studies showed that QLB reduce opiod requirements in the post-operative period. Erector spinae plane block (ESPB) is an interfacial plane block first described in 2016 by Forero et al as an effective treatment method for the treatment of thoracic neuropathic pain. Currently, the ESB is performed as one of the pain management procedures for patients of all generation (newborns, infant, children, adolescents and adults) undergoing abdominal and thoracic surgeries with minimal complications compared to opioid consumption. The aim of this work was to study the post-operative analgesic efficacy of US-guided QLB compared with ESB in CS. Regarding postoperative analgesia as primary outcome by measuring time to first postoperative rescue analgesic request and secondary outcomes by measuring visual analogue scale& hemodynamics& patient satisfaction& time to ambulation and complications incidence. After approval of local scientific and ethical anesthetic committees, this prospective randomized double blinded clinical study was conducted at El-Menoufia University Hospitals. 76 pregnant females were scheduled to have elective CS after spinal anesthesia was randomized into 2 groups to receive either Quadratus lumborum block (QLB Group) and erector spinae block (ESB Group). Each group constitute of 38 patients (n=38): QLB Group: All members of this group were received QLB at end of operation. The QLB was performed by using Isobaric bupivacaine HCl 0.5% (12 ml) + normal Saline NaCl 0.9% (12 ml) + 4 mg dexamethazone (1ml) Reaching volume around 25 ml on each side. Half of the injection was deposited between Quadratus Lumborum muscle & Erector Spinae muscle (QL2), the other half was injected between Psoas major muscle & Quadratus Lumborum muscle (QL3). ESB Group: All members of this group were received ESB at end of operation. All patients had been in lateral position in order to place the high frequency linear probe and see the sonography clearly. Using hyper echoic needle, advanced in plane under the guidance of US. The volume was injected between the erector spinae muscle and transverse processes, a volume of 25 ml composed of (12 ml) Isobaric bupivacaine HCl 0.5% +(12ml) normal Saline NaCl 0.9%+(1ml) 4 mg dexamethazone was injected at each side, after negative aspiration to exclude vascular puncture. |