الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique that provides analgesia to the anterior abdominal wall after lower abdominal surgeries. The anterior abdominal wall components (skin, muscles and parietal peritoneum) are supplied by sensory neurons derived from the anterior rami of spinal nerves T7 to L1. These neurons traverse through the neurofascial plane between the internal oblique and the transversus abdominis muscles. The aim in TAP block is to access these nerves in this neurofascial plane through surface anatomical landmark i.e. “the lumbar triangle of Petit”. This triangle is bounded anteriorly by the external oblique muscle and posteriorly by the latissimus dorsi muscle, whereas the base is formed by the iliac crest. Later on, ultrasound guidance was used in TAP block and offers high success rate with almost no reported complications. The current study was designed to compare the use of bupivacaine alone or combined with fentanyl or epinephrine as adjuvants to bupivacaine in ultrasound-guided TAP block for lower abdominal surgeries. Fifty-six adult patients undergoing elective lower abdominal surgeries under general anesthesia were randomly allocated into three groups; group B received TAP block using 20 ml of bupivacaine 0.25% bilaterally (n=19), group BF received TAP block using 20 ml of bupivacaine 0.25%+fentanyl 50 µg bilaterally (n=18), and group BE received TAP block using 20 ml of bupivacaine 0.25%+epinephrine 5 µg/ml bilaterally (n=19) The primary outcomes from this study were postoperative pain (evaluated by time for first analgesic request (TFAR) and visual analog scale (VAS) for pain scoring) and opioids consumption (intraoperative fentanyl and morphine consumption in the postoperative 24 hours), whereas the secondary outcomes were effect on hemodynamics, Time of extubation, postoperative sedation, and the occurrence of nausea &vomiting and pruritus. Use of intraoperative fentanyl was lower in group BF regarding the amount (8.3±24.3 µg in group BF vs 33.7±41.5 and 36.8±40.4 in group B and BE respectively, P=0.047) & number of patients needed additional doses of fentanyl (2 in group BF vs 8 and 9 in group B and BE respectively, P=0.043), TFAR was longer in group BF (325.1±90.9 in group BF vs 242.6±46.5 and 235.26±50.8 in group B and BE respectively, P=0.008), postoperative VAS for pain score was lower in group BF after 4 hours (P=0.001), morphine consumption in the postoperative 24 hours was lower in group BF (14.2±3.5 in group BF vs 18.9±4.1 and 17.4±4.1 in group B and BE respectively, P=0.003). Time for extubation was shorter in group BF (9.01±2 in group BF vs 10.8±2 and 10.9±1.7 in group B and BE respectively, P=0.009), intraoperative MAP was lower at 30 minutes in group B (P=0.012) &in group BF (P=0.007) with no change in group BE (P=0.245). There were no significance differences in postoperative sedation score, Incidence of postoperative nausea &vomiting and pruritus with no local complications had been reported The conclusion from the current study is that addition of fentanyl as an adjuvant to local anesthetic in ultrasound-guided TAP block decreases the need of intraoperative fentanyl, prolongs the time for first rescue analgesic, lowers postoperative pain scores and decreases the postoperative morphine consumption, , shortens the time of extubation, whereas addition of epinephrine as an adjuvant to the local anesthetic reduces the chance of decrease of mean arterial pressure caused by the local anesthetic without any additional effects on the block characteristics.