الفهرس 
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Abstract
Postoperative analgesia is an integral part of successful surgical outcome. Uncontrolled postoperative pain increases the incidence of postoperative complication. Epidural analgesia with catheter technique remains the most effective analgesic technique after abdominal surgery. However, it has limitation in patients who are either on anticoagulants or have cardiac morbidity due to significant hemodynamic changes which may be detrimental to such patients.
The Transversus Abdominis Plane (TAP) block has been used for postoperative analgesia for abdominal and pelvic surgical procedures. There are several types of abdominal truncal blocks with different effects, such as paravertebral block (which can last for 24 h when using long-acting local anesthetic). TAP block and rectus sheath block (which have shorter time of analgesia), and QLB.
Nevertheless, the anterior approach to the TAP block has shown limited analgesic effect due to its short duration (up to 10 h) and mostly parietal pain relief profile. Ultrasound guided Quadratus lumborum block (QLB) block is a new technique of regional analgesia. There have been reports of excellent post-operative pain management with the QLB for both abdominal and retroperitoneal surgery.
The posterior approach, or Quadratus Lumborum (QL) block, first described in 2007 by Blanco, demonstrated a spread to the paravertebral space, thus leading to a more extensive and long-lasting block, with the potential to provide visceral pain relief.
Therefore, the aim of this work was to evaluate of ultrasound-guided TAP block versus QLB as preemptive analgesia for Inguinal Hernia Repair Surgeries.
A prospective randomized study was conducted on 56 patients with ASA I or II physical status who undergoing elective unilateral inguinal hernia repair surgery. All patients attended to general surgery department, Faculty of Medicine, Menoufia University during the period from February till December 2018. Patients were randomized by use of sealed envelopes technique into two groups:
group T: included 28 patients who received ultrasound-guided TAP block with 20 ml of bupivacaine 0.25%.
group Q: included 28 patients who received ultrasound-guided QLB with 20 ml of bupivacaine 0.25%.
Inclusion criteria:
Patients with ASA I or II physical status.
Aged 18- and 60-years old.
Patients who undergoing elective unilateral inguinal hernia repair surgery.
Exclusion criteria:
Refusal of the patients to give informed consent
Preexisting coagulation disorders.
Known allergies against aminoamide local anesthetics.
Local infection at the site of block.
Morbid obesity.
Hepatic and renal diseases and laparoscopic surgeries.
Parameters of assessment was recorded as follow:
Patient characteristics (age- weight- sex).
Number of dermatomes blocked.
Hemodynamics (pulse- MAP) baseline, every 15 min after induction of general anaesthesia, on admission to post-anesthetic care unit (PACU), every 30 min for the 1st two hours, every 1 hr for next 6 hrs and every 2 hrs for remaining 24 hrs post-operatively.
The total amount of intraoperative fentanyl administered, and number of patients needed it.
Number of patients needed ephedrine and/or atropine and total amount of their administration was recorded.
The anaesthetic time and operative time.
Time to first analgesia request (when VAS is 4 or more).
Analgesia is maintained using morphine (2 mg IV to be repeated after 20 minutes if VAS ≥5 till a maximum of 4 mg/h).
Total amount of morphine consumed during the first postoperative 24 hours.
VAS on admission to post-anesthetic care unit (PACU), every 30 min for the 1st two hours, every 1 hr for next 6 hrs and every 2 hrs for remaining 24 hrs post-operatively.
After 2 and 24 h, the sites of injection of the TAP block and QL block was examined to detect complications such as hematomas or infection.