الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall. Post-operative pain after inguinal hernia lead to the increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Treatment for postoperative pain after abdominal surgical procedure (inguinal herniorrhaphy) based on conventional drugs with pain escape (consisting of maximal does of paracetamol, non-steroidal ant inflammatory drugs, and oral or intravenous opioid), is associated with adverse effects, such as nausea, sedation, hypotension, reduced hung capacity and increased cardiac load. All these effects impede rehabilitation and early discharge.
The aim of the present work was to evaluate the effect of preemptive dexamethasone added to bupivacaine on postoperative pain in patients receiving transversus abdominis plain block (TAPB) guided with ultrasound for inguinal hernia repair as regard the time of the first request for additional analgesia. Pain scores, total analgesic consumption and analgesic efficacy.
The present study was conducted on 30 adult male patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective primary unilateral open inguinal hernia repair
All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS).
Patients were randomized, double blind controlled into two equal groups (15 male patients each).
group I: The patients were received 20 ml of 0.5% bupivacaine with 2 ml 0.9% NaCl which were administered in a TAP block performed with ultrasound guided at same side of the operation.
group II: The patients were received 20 ml of 0.5% bupivacaine with 2 ml dexamethasone (8 mg) which were administered in a TAP block performed with ultrasound guided at side of the operation.
Vital signs were measured as following: Heart rate (beat per minute), mean arterial blood pressure (MABP) in mmHg and Peripheral o2 saturation (SPO2%) were recorded before induction of anesthesia and every 15 minute intraoperative then immediately postoperative, 1, 2, 3, 4 and every 4 hours for the rest 24 postoperative hours constituting the study period.
Pain assessment measured as following:
1. Visual analogue scale during rest (VASR) and movement (VASM) that were recorded immediately postoperative, 1, 2, 3, 4 and every 4 hours for the rest of 24 postoperative hours constituting the study period. Rescue analgesia in the form of nalbuphine 4mg was given IV when VAS scores≥4 at any time post-operative in first 24 hours
2. Duration of analgesia.
3. Total dose of opioids analgesic requirements:
4. Time to the first Rescue opioid analgesic dose:
The present study revealed the following results: As regarding patient demographic data (age, sex, and BMI) was matched between the two groups, as regarding patient MABP at different intervals showed no statistical difference between both groups, the comparison between the two studied groups according to visual analogue scale at rest and movement showed that there were statistically significant decrease in group II than group I., the current study revealed that addition of preemptive dexamethasone to bupivacaine in patients receiving transversus abdominis plain block (TAPB) guided with ultrasound for inguinal hernia repair result in ,longer time till first opioids requirement , prolonged the duration of the block, decreased requirement for opioids, early ambulation, patients more satisfaction and decreased incidence of nausea and vomiting and no local anesthetic toxicity, no hematoma or excessive tissue trauma had been developed at the site of injection in both groups.
CONCLUSIONS
Our study showed that addition of Preemptive dexamethasone to bupivacaine in patients receiving transversus abdominis plain block (TAPB) guided with ultrasound for inguinal hernia repair resulted in: Longer time till first opioids requirement, prolonged the duration of the block, fewer requirements for opioids, early ambulation, more satisfaction and decreased the incidence of nausea and vomiting. As regarding patient complication therewas no local anesthetic toxicity, no hematoma or excessive tissue trauma at the site of injection in both groups.