الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
The QLB is an effective analgesic technique for various abdominal wall incisions. The QLB covers T7 to L2 dermatomes by the spread of LA drugs either into the paravertebral space or in the thoracolumbar plane, through iliohypogastric and ilioinguinal nerves, A and C fiber nociceptors, mechanoreceptors and high-density network of lumbar sympathetic fibers.
The QLB provides somatic and visceral analgesia, hence, we studied the effect of dexamethasone with levobupivacaine in QLB for patients undergoing open inguinal hernia repair surgery
Levobupivacaine is a long-acting LA agent, commonly used for peripheral nerve block due to its better safety profile than that of bupivacaine. Despite long duration of action of levobupivacaine, it cannot provide analgesia for adequate period, hence there is need of adjuvants with LA in block or use of alternative analgesic administration for breakthrough surgical site pain, when effect of block wears off. Various adjuvants have been used and studied to improve the duration of LA action in different peripheral nerves and regional block techniques.
Dexamethasone as an adjuvant to LA has been shown to prolong the duration of pain-free period, less requirement for rescue opioids consumption, more patient satisfaction and lesser incidence of nausea and vomiting. A similar finding was observed in our study.
The addition of dexamethasone is commonly administered as an anti-inflammatory and antiemetic agent, its mechanism as an adjuvant is not completely understood. The possible mechanism may be inhibition of phospholipase A2, potassium channel-mediated nociception transmission, local generation of inflammatory mediators and ectopic neuronal discharge.
After approval of the anesthesiology department and scientific and ethical committees, this prospective double blind randomized clinical trial study was conducted in Ain Shams University Hospitals.
Sixty patients scheduled for elective ingunial surgeries under general anesthesia were included in this study, they were divided into two groups.
group A (perineural dexamethasone and levobupivacaine group) [n=30]
Those cases will receive 2ml volume of dexamethasone (8mg) combined with 18 ml of levobupivacaine of 0.25% concentration.
group B (perineural levobupivacaine group) [n=30]
Those cases will receive perineural 18 ml levobupivacaine (0.25%) combined with 2 ml normal saline.
At the end of this study we found that The addition of dexamethasone to levobupivacaine in QLB in unilateral inguinal hernia repair surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to levobupivacaine alone group.