الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 103 |  |  |
| | | from | 103 | | |
Abstract
In spite of major progress in the management of pain, it continues to be an unacceptable butcommon sequel to surgery. Improving pain management requires that pain is recognized as a priority. The treatment of acute pain is important not only for humanitarian reasons of patient comfort but also because it significantly improves outcome by reducing the incidence of postoperative complications, therefore shortening hospital stay.
Ineffective postoperative pain management can result in a significant dysfunctional complication in substantial number of organ system which may progress to organ damage and even failure. Respiratory dysfunction is the most important complication including small tidal volume, high inspiratory and expiratory pressures, and decreased vital capacity leading to hypoxia.
The aim of the present study was to compare between the effect of U/S guided bilateral rectus sheath block and local infiltration as regard the efficacy of postoperative analgesia and morphine consumption in patients underwent surgery with upper midline anterior abdominal wall incision.
Our study was carried out on 75 patients ASA Ι or ΙΙ admitted to the Medial Research Institute Hospital and scheduled for elective surgeries with upper midline incisions. Patients were randomly divided into three equal groups. The three groups received SGA, group ΙΙ received us guided bilateral RSB at the end of the surgery and group ΙΙΙ received conventional local anaesthetic WI at the end of the surgery.
The day before surgery, all patients were informed with the anaesthetic techniques and trained to use the VAS. They were educated on how to use I.V. morphine PCA.
Standard general anaesthesia was induced in all groups by intravenous fentanyl 2 mcg/kg, propofol (2.5 mg/kg) and cisatracurium (0.15 mg/kg) to facilitate endotracheal intubation. Anaesthesia was maintained with isoflurane (1%). Incremental doses of cisatracurium 0.03 mg/kg were given to maintain anaesthesia.
Rectus sheath blockwas performed at the end of the surgery under aseptic technique.The rectus muscle was imaged with theU/Sprobe in a transverse orientation immediately above the level of the umbilicus beneath the skin and subcutaneous tissue.A 20ml bolus dose of 0.25% bupivacaine was deposited between the muscle and the posterior rectus sheath, with U/S imaging demonstrating correct location.The technique was repeated on the opposite rectus sheath.
At the end of surgery, anaesthesiawas discontinued, residual neuromuscular block was antagonized by atropine 0.01 mg/kg and neostigmine 0.04 mg/kg, the trachea was extubated and patients were transferred to the PACU to be attached with i.v. morphine PCA for the next 24 hours.
Measurements: