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ppendectomy is one of the commonest abdominal operation performed during emergency hours for acute appendicitis. Continuous pain in right iliac fossa even after appendectomy may occur. The assessment of pain in the perioperative period is key to the appropriate management of acute postoperative pain. Pain intensity in the perioperative period is typically assessed with use of one dimensional scales such as the visual analogue scale (VAS), the four-point verbal rating scale (VRS), or the numeric rating scale (NRS).
TAP block has been shown to provide good postoperative analgesia as it provides analgesia to the skin, muscles and parietal peritoneum of the anterior abdominal wall from T6 to L1. It has multiple benefits as it decreases prolonged stay in the PACU improves patient comfort and may improve compliance with postoperative care such as ambulation and respiratory exercise.
The ultrasound guided TAP block increases its safety and its complication rate is considered minimal as compared to the blind technique. Local anesthetics are defined as drugs interrupt neural conduction by inhibiting the influx of sodium ions through channels within neuronal membrane.
Studies concluded that addition of magnesium sulfate to local anesthetics for neuraxial anesthesia prolongs the duration of anesthesia and improves the quality of analgesia. However, there are few clinical studies assessing the addition of magnesium for peripheral nerve blocks.
We conducted a study over 60 patients undergoing open appendectomy under general anesthesia, divided them into 2 groups using computer generated table placing them in sealed envelope then opening the envelope in the OR:
1. group 1: consists of patients receiving TAP block with Bupivacaine (0.5%20ml diluted in 20 ml saline) only.
2. group 2: consists of patients receiving TAP block with Bupivacaine (0.5% 20ml diluted in 15ml saline) and Magnesium sulphate (0.5 gm magnesium sulphate 5 ml).
TAP block will be performed at the end of he surgery and before extubation of the patient. HR, MABP will be recorded at 4,6,12 and 24 hrs, asse VAS analogue score at 4,6,12&24 hrs post operative & recoding time of asking for 1st rescue dose of nalbuphine.
Our study concluded that co administration of 500mg MgSo4 to 0.5 % bupivacaine in US guided TAP block in cases of open Appendectomy resulted in a better analgesic profile, lower VAS score, lower analgesic consumption, and longer duration of analgesia.
gSO4 as an adjuvant to bupivacaine in Ultra-sounded guided TAP block reduces post-operative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.