الفهرس 
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Abstract
Surgical pain is due to inflammation from tissue trauma (i.e., surgical incision, dissection, burns) or direct nerve injury (i.e., nerve transaction, stretching, or compression). The patient senses pain through the afferent pain pathway which can be altered by various pharmacologic agents Major open upper and lower abdominal surgery, such as abdominal aortic surgery, bowel resection, gastric bypass, gynecologic surgery and liver resection results in major morbidity for patients, including moderate to severe pain in the acute postoperative period . Data on postoperative pain after surgery consistently shows moderate-to-severe pain in the first 24 hours after surgery with traditional systemic analgesic techniques, such as intravenous or intramuscular opioids, patient-controlled opioid analgesia, and multimodal analgesia with opioids combined with acetaminophen, NSAIDs, neuropathic agents, and ketamine.
Aim of the study: the study was done to evaluate efficacy of ultrasound guided continuous lumbar paravertebral block versus continuous transversus abdominis plane block versus continuous lumbar epidural block , in the management of the postoperative pain in patients undergoing abdominal surgeries (unilateral inguinal hernia repair) . Patients and methods: This Prospective, single blind randomized clinical study,in which 60 Patients were randomized into three equal groups , group P (20 patients received ultrasound guided continuous lumbar paravertebral block with 20 ml bupivacaine 0.5% bolus dose, followed by continuous infusion (0.1 ml/kg/hr)of bupivacaine 0.25% . group T (20 patients received ultrasound guided transversus abdominis plane block with 20 ml of bupivacaine 0.5% followed by continuous infusion (0.1 ml/kg/hr) of bupivacaine 0. 25%, and group E (20 patients received continuous lumbar epidural analgesia with 20 ml bupivacaine 0.5% bolus dose, followed by continuous infusion (0.1 ml/kg/hr) of bupivacaine 0. 25% .Patients with Local skin infection at the site of injection , known allergy to one of the used drugs , age < 18 years old , coagulopathy , morbid obesity or history of seizure were excluded of the study . One day before surgery all patients were interviewed to explain visual analogue scale (VAS) , also routine investigations were fulfilled. Before the induction of general anaesthesia , Intravenous access (IV) was established and fluids started, monitoring of the patients. Induction of general anaesthesia in patients undergoing lower abdominal surgeries (inguinal herniorrhaphy) were premedicated with IV midazolam, 30 minutes before the operation . After pre-oxygenation , general anesthesia was induced with fentanyl 1-2 mcg/kg and propofol 1–3 mg/kg followed by rocuronium 0.6 mg/kg to facilitate endotracheal intubation .
End tidal CO2 was monitored with capnography. Anesthesia was maintained with isoflurane 1.2% and rocuronium 0.15 mg/kg as a maintenance dose every 30 minutes till the end of the procedure. Heart rate was continuously monitored and MAP/ 5 minutes was maintained within ± 20% of the preoperative baseline.