الفهرس 
Pathophysiology of PainOnly 14 pages are availabe for public view
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Abstract
Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.
The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses.
In order to blunt the autonomic and somatic reflex responses to pain and to enhance subsequent restoration of the function of different body-organs as breathing, coughing, and moving easily, together with resumption of oral feeding, and early hospital discharge.
Many studies have been carried out trying to find a solution for these dilemma thus different pain modalities as local infiltration of the surgical field, systemic analgesia (narcotics and non-narcotics), neuro-axial blocks, and nerve blocks shined out, however each has shown its side effect which limits its use to specific cases.
Abdominal field blocks have been extensively used for a variety of surgical procedures for many years. They are simple to perform and have a good safety profile.
The aim of this study is to assess the postoperative analgesic efficacy of continuous transversus abdominis plane (TAP) block using Accufuser compared to patient-controlled injection after caesarean section regarding the pain relief and the amount of local anesthetic used.
The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each:
Patient controlled analgesia Group: received general anaesthesia and bupivacaine bolus 1 mg/kg (0.25%) and 0.25 mg/kg (0.125%) as rescue analgesia at (VAS) > 5 through the catheters in each side.
Continuous Infusion Group: received general anaesthesia and bupivacaine bolus 1 mg/kg (0.25%) followed by infusion 5 ml/hr. (0.125%) by the Accufuser through a 3-way stop cock to feed the catheters on each side.
The two groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total consumption of it in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed.
The results of the study revealed that there is no significant difference between continuous infusion of bupivacaine in transversus abdominis plane block and patient controlled analgesia regarding the postoperative analgesia after caesarean section. While the amount of bupivacaine consumption in continuous infusion is greater than that of the patient controlled injections.