الفهرس 
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Abstract
Pain is an everyday challenge during all surgeries and it is a chief
post-operative complication, so pain management is a corner stone in
anesthetic practice. CS surgeries are usually associated with acute postoperative
pain and restricted mobility.
US-guided nerve block is a considered technique for pain
management. It provides better visualization of the nerves and reduces the
risk for complications e.g. unintended injury to adjacent structures.
Quadratus lumborum block (QLB) was first described by Blanco17.
The main advantages of QLB compared to TAP block is the extention of
local anesthetic agent beyond the transversus abdominis plane to thoracic
paravertebral space. The wider spread of the local anesthetic agents may
produce extensive analgesia, prolonged action of injected local anesthetic
solution and blocking of visceral pain. Previous studies showed that QLB
reduce opiod requirements in the post-operative period.
Erector spinae plane block (ESPB) is an interfacial plane block first
described in 2016 by Forero et al as an effective treatment method for the
treatment of thoracic neuropathic pain. Currently, the ESB is performed as
one of the pain management procedures for patients of all generation
(newborns, infant, children, adolescents and adults) undergoing abdominal
and thoracic surgeries with minimal complications compared to opioid
consumption.
The aim of this work was to study the post-operative analgesic
efficacy of US-guided QLB compared with ESB in CS. Regarding postoperative
analgesia as primary outcome by measuring time to first postoperative
rescue analgesic request and secondary outcomes by measuring visual analogue scale& hemodynamics& patient satisfaction& time to
ambulation and complications incidence.
After approval of local scientific and ethical anesthetic committees,
this prospective randomized double blinded clinical study was conducted at
El-Menoufia University Hospitals. 76 pregnant females were scheduled to
have elective CS after spinal anesthesia was randomized into 2 groups to
receive either Quadratus lumborum block (QLB Group) and erector spinae
block (ESB Group). Each group constitute of 38 patients (n=38):
QLB Group: All members of this group were received QLB at end
of operation. The QLB was performed by using Isobaric bupivacaine HCl
0.5% (12 ml) + normal Saline NaCl 0.9% (12 ml) + 4 mg dexamethazone
(1ml) Reaching volume around 25 ml on each side.
Half of the injection was deposited between Quadratus Lumborum
muscle & Erector Spinae muscle (QL2), the other half was injected
between Psoas major muscle & Quadratus Lumborum muscle (QL3).
ESB Group: All members of this group were received ESB at end of
operation. All patients had been in lateral position in order to place the high
frequency linear probe and see the sonography clearly.
Using hyper echoic needle, advanced in plane under the guidance of
US. The volume was injected between the erector spinae muscle and
transverse processes, a volume of 25 ml composed of (12 ml) Isobaric
bupivacaine HCl 0.5% +(12ml) normal Saline NaCl 0.9%+(1ml) 4 mg
dexamethazone was injected at each side, after negative aspiration to exclude vascular puncture.