الفهرس 
Perioperative pain and AnalgesiaOnly 14 pages are availabe for public view
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Abstract
Pain management in patients with Liver cirrhosis is considered a challenge for health care providers regarding risk of oversedation by opioids, and association of analgesic drugs such as paracetamol and NSAIDs with GIT bleeding, hepatorenal syndrome and drug toxicity.
Multimodal analgesia is the optimum strategy for control of perioperative pain to minimize opioids needs.
QLB is a block of the posterior abdominal wall, ―interfascial plane block,‖ which is performed exclusively under ultrasound guidance. It was described by anesthesiologist Dr. Rafael Blanco 2007,it generates an analgesic effect by unilaterally blocking spinal nerves from T6–T9 to L1L3.
Four types of QLB were described, QLB1 or lateral QLB, QLB2 or posterior QLB, QLB 3 or trans muscular QLB, and QLB 4 or intramuscular QLB.
Aim of the study
Our study aimed to asses effect of continuous anterior QLB on alleviating pain, opioid consumption and hemodynamic in cirrhotic patients undergoing major abdominal surgery.
Patients and methods
60 patients were included in the study undergoing Whipple, resection and HJ,JJ, ultrasound guided anterior QLB was performed with continuous infusion using epidural catheter,patients divided into 2 groups group B (bupivacaine injection) and group S (saline injection) both groups were compared for intraoperative and postoperative opioid consumption, hemodynamics, VAS score and postoperative complications.
Our study revealed that ultrasound guided anterior QLB reduce opioid consumption intraoperative with mean 337.9+-SD 135.39 ug in group B and518.33+-121.40 ug in group S and postoperative (mean312+SD170.36 in group B and 582+_141.16 in group S), and decrease VAS score when used as multimodal analgesia after 1/2h it was 5.10 +-1.06 in group B compared to 6.03 +-0.41 in group S, after 6 h, 3.53 +-0.82 in group B compared to 4.66 +-0.81 in group S.
Intraoperative hemodynamics were signicantly different between 2 groups beginning from the 2nd hour and the successive hours,there was no clinical significant difference in postoperative hemodynamics.
postoperative nausea and vomiting was decreased in patients undergoing anterior CQLB with percentage of patients who developed N&V 30% in group B compared to 63.33% in group S, no difference between 2 groups regarding postoperative chest complications.
No patient was reported to develop post operative muscle weakness in lower limb.