الفهرس 
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Abstract
In this study 68 patients of ASA I and II aged between 20 and 50 years old of both gender were scheduled for elective laparoscopic cholecystectomy under general anesthesia in Gastroenterology Center at Mansoura University. Exclusion criteria were Patient’s refusal to participate in the study, neuromuscular, hematological and psychatric diseases, allergy to any medication used in the study, body mass index>35 kg/m2, local skin infection and sepsis at site of the block, pregnancy or presence of chronic pain. Patients were divided into two groups (34 patients in each group): Erector spinae plane block group (ESPB) (n=34): received 20 ml bolus bupivacaine 0.25% in each side (10 ml bupivacaine 0.5% + 10 ml distilled water). Quadratus lumborum block group (QLB) (n=34): received 20 ml bolus bupivacaine 0.25% in each side (10 ml bupivacaine 0.5% + 10 ml distilled water). The day before the surgery, the study protocol, erector spinae plane and quadratus lumborum blocks procedures were explained to all patients and all patients were familiar with the use of VAS score identifying 0 point as no sense of pain and 10 point as severe imaginable sense of pain. Base line values of heart rate, oxygen saturation and non-invasive blood pressure were registered just before induction of general anesthesia, immediately after the block, then recordings were every 15 min for the first hour and then every 30min interval till the end of surgery. In case of increase in intra-operative MAP or HR > 20% of baseline values for longer than 5 min, incremental doses of fentanyl 0.5 ug/kg will be given I.V. The total dose of fentanyl consumed in the intra-operative period was recorded in both groups. And Once transferred to post anesthesia care unit (PACU), all vital data & hemodynamics (heart rate, oxygen saturation, mean blood pressure) were recorded by an data collector at 0 h (immediate on arrival), 2h, 4h, 6h, 12h and 24h post-operatively. Also, pain was measured with the 10 point visual analogue scale as score 0 point was defined as no pain and score 10 point was defined as the worest severe pain. A bolus dose of IV fentanyl 20 ug fentanyl was administered when VAS > 3. The time period for the first analgesic requirement which represents duration of analgesia of the block was recorded. The dose of fentanyl (ug) used up in the first 24-hour postoperative period was registered in both groups. Any adverse effects were recorded and managed like : • Nausea,vomiting. • Respiratory depression(Sp02 < 92%). • Hypotensive episodes (blood pressure < 20%). There were no significant statistical differences between the two studied groups as regards demographic data, hemodynamics and perioperative oxygen saturation. As regards the postoperative pain using the visual analogue scale (VAS) for 24 hrs postoperatively from the time of injection. VAS was significantly decreased in ESPB group when compared to QLB group. Considering the time of first request to rescue analgesia was significantly prolonged in ESPB group than in QLB group. Also the total analgesic (fentanyl) requirements in 24 h were significantly lower in ESPB group than in QLB group. There was no statistically significant difference between the two groups as regards to the intra-operative fentanyl consumption. We did not find any statistically difference between the two groups as regards to the side effects (nausea and vomiting). The current study concludes that, from the results, ESP block provided better quality of post-operative analgesia, less post-operative opioid consumption and better recovery variables than QL block after laparoscopic cholecystectomy.