الفهرس 
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Abstract
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 regional anethesia.
Transversus abdominis plane (TAP) block has been increasedly used for postoperative pain relief after lower abdominal surgeries. 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 effect of addition dexamethasone or magnesium with bupivacaine in ultrasound-guided QLB to prolong it’s duration in patients undergoing open abdominal surgeries 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, patients undergoing open abdominal surgeries were included in the study, and were divided into three groups (n=22; each); group M, D and group C.
where in group M patients received 20 ml bupivacaine 0.25% plus 5 ml of 10% MgSO, and group D patients (n=22) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl and in group c ( control) Patients (n=22) received 20 ml bupivacaine plus 5 ml 0.9% NaCl.
The three groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia. Demographic data, post-operative hemodynamics, and total analgesic consumption were also assessed.
The thesis proved that the addition of either magnesium sulfate or dexamethasone to bupivacaine 0.25% in ultrasound guided QLB for open abdominal surgeries hastened the onset, prolonged the duration of sensory block, increased post-operative analgesia and decreased rescue analgesia needed without increasing the risk of adverse effects, with Dexamethasone showed better results.