الفهرس 
Pathophysiology of Pain
Overview of Ultrasound-Guided Transversus Abdominis Plane BlockOnly 14 pages are availabe for public view
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Abstract
Obesity has been associated with an increased hazard ratio for all-cause mortality, as well as significant medical and psychological co-morbidity. Bariatric surgery procedures are indicated for patients with clinically severe obesity. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization.
In the past few years, transversus abdominis plane (TAP) block has been increasingly used for postoperative pain relief after laparoscopic surgery. The main advantage of quadratus lumborum block (QLB) compared to TAP block is the extension of local anesthetic agent beyond the transversus abdominis plane to the thoracic paravertebral space. The wider spread of the local
anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution.
The aim of this study was to assess the analgesic efficacy of ultrasound-guided QLB compared with TAP block and intravenous opioid drugs during laparoscopic bariatric surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions.
After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, sixty morbidly obese patients were included in the study, and were divided into three groups (n=20; each); group QLB, group TAP and group GA.
group QLB: patients (n=20) of this group received bilateral ultrasound-guided QLB after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%.
group TAP: patients (n=20) of this group received bilateral ultrasound-guided TAP block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%.
group GA: patients (n=20) of this group received general anesthesia and then IV morphine (0.1 mg/Kg LBW).
The three groups were adequately monitored and assessed intra-operatively and post-operatively. They were compared regarding analgesic outcome by using the visual analogue scaling system, and recording the time needed for the first call of rescue analgesia and its total consumption in the first 24 postoperative hours. Demographic data, intra-operative and post-operative hemodynamics, and sedation score were also assessed.
The results of this study revealed that QLB was the most effective technique in providing analgesia after laparoscopic bariatric surgery without associated hemodynamic instability in comparison to TAP block and intravenous opioid drugs. TAP block had the ability to provide an intermediate option between general anesthesia with intravenous opioids and general anesthesia with QLB and could be an effective modality when QLB could not be performed.