الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice.
Total Laparoscopic Hysterectomy (TLH) is a minimally invasive procedure, it has certain advantages over an open abdominal hysterectomy, such as reduced pain, less incidences of wound infection, a rapid recovery, a shorter hospital stay and lower complication
Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g., unintended injury to adjacent structures.
ESPB is a new technique for providing postoperative analgesia after TLH that relies upon injecting local anesthetic under the erector spinae muscle and into the interfacial plane between this muscle and the transverse processes, as it is devoid of major adverse effects like pneumothorax or spinal cord trauma.
The present study was designed to assess the analgesic efficacy and safety of ultrasound guided ESPB done at thoracic transverse process level in patients undergoing TLH for postoperative analgesia and compare it to the PCA.
The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent.
It included a total of 64 adult females patient aged 40-65 years, scheduled for TLH. Patients were randomly divided into two equal groups 32 patients each, according to the inclusion and exclusion criteria.
The ESPB group (n=32): received ESPB after the end of operation and before recovery from general anaesthesia, while the other group (n=32): receive PCA (accufuser) 100 ml filled with 20 mg Morphine, 60 mg Ketorolac and 3mg Granisetron.
The main finding in this study was that ultrasound guided ESPB at level of thoracic process provided a good analgesic effect in patients undergoing TLH also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake.