الفهرس 
Physiology of PainOnly 14 pages are availabe for public view
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Abstract
When a noxious stimulus produces tissue injury, chemical mediators are released and activate nociceptors which in turn generate nerve impulses. Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response.
Abdominal hysterectomy is a common surgical procedure usually associated with moderate to severe postoperative pain. Adequate relief of postoperative pain is mandatory to facilitate patient recovery to normal function and to reduce neuro-endocrinal stress responses, central sensitization of the nervous system and muscle spasms which occur in response to uncontrolled pain.
Opioid analgesic therapy has served as the mainstay of acute postoperative pain treatment, however it is an enduring challenge for health care providers and should be targeted to provide adequate analgesia for increased pain sensitivity of opioid-induced hyperalgesia, prevent withdrawal that might produces sympathetic over-stimulation and heightens stress responses, and finally to avoid triggering a relapse or worsening of the addiction disorder.
This led to increasing demands for developing pain treatment strategies using a multi-modal opioid sparing approaches. Abdominal wall blocks has been one of the most preferable regional anesthetic techniques. With the advancement of ultrasound technology, TAP blocks become technically easier and safer to perform and became effective adjuncts for analgesic therapy after a variety of abdominal surgeries, such as cesarean section, hysterectomy, cholecystectomy, colectomy, prostatectomy, and hernia repair.
There are several different approaches for ultrasound guided TAP block, such as lateral, posterior and subcostal approaches. There has been evidence supporting the idea that different approaches of TAP blocks can also affect the analgesic outcomes.
The purpose of this study was to compare the effectiveness of subcostal versus lateral TAP blocks for post-operative pain management in patients undergoing total abdominal hysterectomy.
The study was performed upon 100 patients electively scheduled for total abdominal hysterectomy under general anesthesia and randomly distributed among two groups:
group A: (n = 50): patients enrolled for postoperative Subcostal TAP block.
group B: (n = 50): patients enrolled for postoperative lateral TAP block.
For each patient, the following data were collected: age, height, weight, duration of surgery, ASA, intraoperative and postoperative hemodynamic changes, pain scores, pethidine consumption and time of postoperative mobility.
These results demonstrated that performing postoperative bilateral US-guided subcostal TAP block in group (A) was associated with significant increase in heart rate, mean arterial blood pressure, pain scores and pethidine requirements postoperatively in comparison to bilateral US-guided lateral TAP block in group (B) which provided more effective postoperative analgesia than subcostal approach.