الفهرس 
Physiology of pain of upper abdominal surgeryOnly 14 pages are availabe for public view
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Abstract
Abdominal wall incision is the major contributor to the pain experienced by patients after abdominal surgery. Analgesic multimodalities were recommended to relieve the post-operative pain. Although opioids provide satisfactory analgesia, they are associated with unwanted side-effects. Pain and other sensations from the abdominal wall are transmitted to the brain by the anterior branches of approximately seven spinal nerves (T6 to L1). These nerves are travelling in a plane between the internal oblique and transverses abdominis muscles. This plane, known as the transversus abdominis plane (TAP). Subcostal TAP block has been reported to provide analgesia for incisions extending above the umbilicus. Adjuvant medications were added to LA to prolong the effect of TAP block. Various adjuvants have been used to increase quality and prolong the local anesthetic effect as fentanyl, clonidine, buprenorphine, dexamethasone and others. Dexamethasone is a high-potent, long-acting glucocorticoid and has been shown to prolong peripheral nerve blockade. Ultrasound is becoming an important in regional anesthesia, allowing real-time imaging of nerves. This increases rates of achieving a successful block by allowing visualization of the injectate entering the correct plane. The current study was designed to evaluate the postoperative analgesic effect of dexamethasone addition to bupivacaine in US guided subcostal TAP block on total narcotics consumption, timing of postoperative analgesic requirement and visual analogue scale (VAS) postoperative. Forty four patients of American Society of Anesthesiologists (ASA) physical status I-II of both sexes, aged > 18 < 60 years underwent upper abdominal surgeries were included in the study. Randomization of patients was
Summary
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made into two equal parallel groups 22 patients in each. group LD received 20 ml bupivacaine (0.25%) and 2ml (8mg) dexamethasone. group L received 20ml 0.25%bupivacaine. Demographic data of patients (age, sex, BMI and type of surgeries) were comparable between both groups but no statistically significance difference. Pethidine consumption in 24 hrs, was significantly higher among L group than LD group (p=0.002*). Also intraoperative fentanyl consumption was higher in L group. (p=0.273). As regards first time of analgesia was significantly longer among dexamethasone (LD) group than bupivacaine (L) group (p=0.011*). Regarding postoperative visual analogue scale, At 1st, 3rd, 6th and 24 hours postoperative, It was less in group LD at 1st hour postoperative than group L (P=0.034*). Nausea and vomiting were less in group L. There is no statistically significant difference in HR and MABP measurments intra, postoperative except at time one hour postoperative [T12] with no clinical value. Effective post-operative analgesia is an essential component of the care of surgical patients. It decrease the Surgical stress response occurring as a result of uncontrolled pain after surgeries which severely affects various physiological functions, even leading to increased perioperative morbidity and mortality. In conclusion, the addition of dexamethasone 8 mg to bupivacaine 0.25% for TAP block provides prolongation of the duration of the block and decreases the incidence of postoperative nausea and vomiting that may have a great impact on patient comfort.