الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The caesarean section is the most commonly performed surgery in gynecology and obstetrics in the world, which is a steadily increasing trend. Unsuccessfully conducted analgesia after caesarean section results in considerable suffering in newly delivered mothers, who consequently may be less willing to feed and care for the new-born. To achieve effective analgesia, a multimodal strategy should be used with simultaneously administered painkillers from all three levels of the analgesic ladder in conjunction with specialized peripheral nerve block techniques.
The aim of this study was to evaluate the effectiveness of ultrasound guided Quadratus Lumborum Block vs TAP Block in postoperative analgesia and opioid consumption after cesarean section.
This study was carried out on 40 patients ASA I or II with a gestation of at least 37 weeks admitted to Elshatby Hospital and scheduled for elective caesarean section. The patients were randomly assigned to one of two equal groups (20 in each group), via the sealed envelope technique. QLB1 group: received spinal anaesthesia and bilateral US-guided QLB block while TAP Block group received spinal anaesthesia and bilateral US-guided TAP Block.
All patients were informed with the anaesthetic techniques and trained to use the visual analogue scale (VAS).
On arrival to the operative theatre a peripheral venous catheter was inserted in all patients, multichannel monitor was attached to the patient to display ECG (lead II), heart rate (beats/min), non-invasive mean arterial blood pressure (mmHg) and oxygen saturation (SpO2).
All patients received 40 mg Famotidine at night before surgery and Ondansetron 4 mg just before as antiemetic. Spinal anesthesia was performed in the sitting position at the L3–4 interspace with 12.5 mg 0.5% hyper-baric using 25 gauge Quincke needle. After wound closure, patients allocated to the QLB I group received bilateral ultrasound guided Quadratus Lumborum block I using 20 ml 0.25% bupivacaine for each side ,while patients allocated to the TAP Block group received bilateral ultrasound guided TAP Block using 20 ml 0.25% bupivacaine for each side.
The patients of both groups were admitted to the ward and received 1 g of paracetamol IV every 8 hour.
Postoperative pain assessment using VAS was recorded at 2h, 4h, 6h, 12 h and 24 h postoperatively and total amount of IV nalbuphine was recorded at the end of the 24 postoperative hours as well as the time of the first dose required by the patient. Patient satisfaction with pain management was evaluated by the anaesthetist before patients were discharged home.
The obtained results were as follows:
• No significant differences were present between the two groups regarding demographic data (age, weight, height and BMI).
• No significant differences were present between the two groups regarding the vital signs (heart rate, mean arterial blood pressure) in all time intervals except at 12 hours 24 hours postoperative as they were lower in QLB group.
• VAS score was significantly lower in QLB group compared with TAP group at 4hr, 6hr,12hr and 24hr.
• The total amount of postoperative IV nalbuphine consumption was significantly lower in the QLB group compared to the TAP Block group, (p<0.001).
• None of the patients developed cardiovascular instability or haematoma at the site of injection.
• There was no significant difference between the two studied groups in the incidences of PO Nausea & Vomiting.
• Patients satisfaction was significantly higher in QLB 1 group compared to TAP Block group (p=0.008).
It is concluded that :
• Ultrasound guided quadratus lumborum block is more effective method than TAP block for postoperative analgesia in patients undergoing caesarean section as it is more effective in reducing both somatic and visceral pain.
• Ultrasound guided quadratus lumborum block is associated with decrease in the total opioid consumption, longer duration of analgesia and higher patient satisfaction.
It is recommended that:
• Ultrasound guided QLB block and TAPB in the current study should be used as a part of multimodal analgesia in caesarean section.