الفهرس 
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Abstract
This prospective randomized double blind controlled study was conducted on 90 adult patients of both sex at El-Minia University Hospital in the period from (February 2017 to December 2017) aged 18-70 years, of American Society of Anesthesiologists (ASA) physical status IE to IIIE, scheduled for emergency laparotomies under general anesthesia, after obtaining Institutional Ethical Committee approval and written informed consent.
This study aimed to evaluate efficacy and safety of ultrasound guided four quadrant injection TAP block in emergency laparotomies and compared the effect of adding dexamethasone or magnesium as an adjuvant to bupivacaine.
The patients were randomly allocated into three parallel equal groups by using a computer-generated table and the randomization sequence was concealed in sealed envelopes assignment held by an assistance who not involved with the clinical management or data collection.
• group C (Controlled group): received ultrasound guided four quadrants injection TAP block using a bolus injection of 38 ml isobaric bupivacaine hydrochloride 0.25% + 2ml saline 0.9% before skin incision (10ml on each quadrant).
• .group D (Dexamethasone group): received ultrasound guided four quadrants injection TAP block using a bolus injection of 38 ml isobaric bupivacaine hydrochloride 0.25% + 8mg dexamethasone (2ml) before skin incision (10ml on each quadrant).
• group M (Magnesium sulphate group): received ultrasound guided four quadrants injection TAP block using a bolus injection of 38 ml isobaric bupivacaine hydrochloride 0.25% + 200 mg magnesium sulphate (2ml) before skin incision (10ml on each quadrant).
All patients were assessed in terms of:-
1) Hemodynamic (MAP and HR) and SaO2 intraoperatively after induction of GA and at 15, 30, 45min, 1, 1.5, 2, and 2.5 hrs after TAP block and postoperatively at 1, 2, 4, 6, 8, 10, 12, 18 and 24 hrs.
2) Postoperative visual analogue pain scale score (VAPs) at 1, 2, 4, 6, 8,10, 12, 18 and 24 h.
3) Analgesic requirement including number of patients required intra & postoperative fentanyl, the time of 1st analgesic request and the total 24 hrs of analgesic requirements (if VAS was ≥4, analgesics in the form of paracetamol 15 mg/kg IV was given with a maximum dose of 90 mg/kg/day. If the analgesia was not adequate intravenous fentanyl at 1μg/kg was given).
4) Incidence of complications.
5) Time of discharge from ICU.
Our results recorded that the patient characteristics (age, gender, weight, ASA classification, surgical time and operation type) and SaO2 were comparable between three studied groups.
The use of four quadrant TAP block was safe, effective and attenuated the hemodynamic stress response to surgery. Adding dexamethasone or magnesium to bupivacaine delayed the time of first analgesic request, decreased the total amount of postoperative analgesics, more hemodynamic stability in comparison to bupivacaine alone and magnesium sulfate was superior over dexamethasone in achieving these advantages.