الفهرس 
Introduction
Pathophysiology of PainOnly 14 pages are availabe for public view
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Abstract
Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.
The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses.
In order to blunt the autonomic and somatic reflex responses to pain and to enhance subsequent restoration of the function of different body-organs as breathing, coughing, and moving easily, together with resumption of oral feeding, and early hospital discharge.
Many studies have been carried out trying to find a solution for these dilemma thus different pain modalities as local infiltration of the surgical field, systemic analgesia (narcotics and non narcotics), neuro-axial blocks, and nerve blocks shined out, however each has shown its side effect which limits its use to specific cases.
Abdominal field blocks have been extensively used for a variety of surgical procedures for many years. They are simple to perform and have a good safety profile.
The aim of this study is to assess the analgesic efficacy and hemodynamic effects of bilateral ultrasound guided single injection subcostal Transversus Abdominis Plane (TAP) Block compared with thoracic epidural block and intravenous opioid-non steroidal anti-inflammatory drugs after upper abdominal surgery. Each of them combined with general anesthesia in patients undergoing upper abdominal surgery.
The study was conducted on 60 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in three groups of 20 patients each:
group TAP: bilateral ultrasound guided Subcostal TAP block was performed after induction of general anesthesia using 20 ml of 0.375% bupivacaine in each side.
group EA: thoracic epidural catheter was placed between T8, T9 and an initial dose with 8ml of bupivacaine 0.25 % and 50µg fentanyl were injected before induction of general anesthesia, the thoracic epidural analgesia was maintained with 5 ml /hour by 0.125 bupivacaine and 2µg/ml fentanyl during the surgery.
group GA: received general anesthesia. Patients received intravenous fentanyl infusion and non steroidal anti-inflammatory drug.
The three groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesa and total consumption of it in the 1st 24 postoperative hours. Demographic data, intra and post operative hemodynamics, and sedation score were also assessed.
The results of the study revealed that that single injection subcostal tansversus abdominis plane block has more analgesic efficacy than combined intravenous opioid and non steroidal anti-inflammatory drug analgesia, while continuous thoracic epidural analgesia was more effective than single injection subcostal tansversus abdominis plane block. The first call for rescue analgesia (morphine), total morphine consumption and pain scores (visual analog score at rest and movement) indicated that the superiority of the 2 analgesic techniques (TAP Block and Thoracic epidural) was attributed to their opioid sparing effect.