الفهرس 
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Abstract
This prospective, double-blinded, randomized, controlled study was performed at Minia University Hospital during the period from July 2018 to June 2019. Ninety-three patients of both sexes, age ranged from 20-50 years, ASA I to III E were scheduled for emergency laparotomy under general anesthesia.
The aim of our research was to compare the analgesic effect of ultrasound ESPB versus ultrasound guided four quadrants TAPB in patients undergoing emergency laparotomy.
After approval of the Research Ethics Board, the patients were allocated randomly into 3 groups each contains (31) patient.
Control group: did not received block and received standard anesthesia protocol.
• TAPB Group: received u/s guided four quadrants injection TAP block (posterior TAPB and subcostal TAPB) using a bolus injection of 40 ml isobaric bupivacaine hydrochloride 0.25% before skin incision (10ml on each quadrant).
• ESPB Group: received u/s guided bilateral injection ESP block using a bolus injection of 40 ml isobaric bupivacaine hydrochloride 0.25% before skin incision (20 ml on each side).
The following Variables: HR, MAP, VAPS, time to first analgesic demand, total Analgesic consumption, patient satisfaction and complications were Recorded periodically and compared between groups.
At rest, TAPB and ESPB groups recorded significantly lower pain scores for 12 and 18 h; respectively also there was significant decrease at 2, 4, 6 and 8 h in ESPB group compared to TAPB group postoperatively. While pain scores at movement, ESPB group recorded significantly lower values for the first 8 h than TAPB group and also both study groups demonstrated significantly lower pain score than control group for the first 8 h for ESPB group and for the first 4 h for TAPB group. The time to first analgesic demand was significantly longer in ESPB patients (14.9±5.7 h) than TAPB patients (6.5±2.2 h) and both study groups were significantly longer than control patients (2.8±1.6 h). Fentanyl consumed postoperatively in ESPB group (40.3±26.7 mcg) was significantly lower than TAPB group (111±38.1 mcg) and both study groups were significantly lower than control group (175±38.9 mcg) in the first 24 h.
We concluded that Bilateral ultrasound guided ESPB using 40 ml bupivacaine 0,25% decreases resting and dynamic pain score, fentanyl requirement and prolongs duration of analgesia postoperatively than TAPB using 40 ml bupivacaine 0,25% for patients undergoing emergency laparotomy.
Based on our results of the current research:
• We recommend the use of ESPB with systemic analgesia as a part of multimodal analgesia protocol, because it is an easier and faster procedure, provide somatic and visceral analgesia and hemodynamic stability for emergency laparotomy.
• We recommended further more randomized controlled study on a large sample size to confirm our results
• We recommend future studies using a catheter for longer period of analgesia
• We recommend further studies using adjuvants added to ESPB to assess efficacy.