الفهرس 
ANATOMICAL CONSIDERATIONSOnly 14 pages are availabe for public view
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Abstract
P
oorly controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.
The analgesic regimen used for postoperative pain control 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.
Many studies have been carried out trying to find a solution for this 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 postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to intraperitoneal and periportal infiltration with bupivacaine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.
All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS).
The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each:
TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance.
Intraperitoneal and periportal infiltration Group: received general anesthesia and 20 ml of 0.25% bupivacaine was injected under the direct vision into the hepato-diaphragmatic space, near and above the hepato-duodenal ligament and above the gall bladder before removal of the probes, also 20ml of 0.25% bupivacaine was injected at the port sites at the end of operation.
The two groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system at rest and upon coughing, besides recording time for first analgesic need and total consumption of morphine and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed.
The results of the study revealed that the Patients receiving TAP block had significantly lower pain scores at rest for 6 hrs and upon coughing for 6 hrs also after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received Intraperitoneal and periportal infiltration.