الفهرس 
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Abstract
Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.
The analgesic regimen used for postoperative pain control needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses.
In order to blunt the autonomic and somatic reflex responses to pain and to enhance subsequent restoration of the function of different body-organs as breathing, coughing, and moving easily, together with resumption of oral feeding, and early hospital discharge.
Many studies have been carried out trying to find a solution for this dilemma thus different pain modalities as local infiltration of the surgical field, systemic analgesia (narcotics and non-narcotics), neuro-axial blocks, and nerve blocks shined out, however each has shown its side effect which limits its use to specific cases.
Abdominal field blocks have been extensively used for a variety of surgical procedures for many years. They are simple to perform and have a good safety profile.
The aim of this study was to assess the postoperative analgesic efficacy of Quadratus Lamborum (QL) block compared to intraperitoneal and periportal infiltration with bupivacaine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, time of first rescue analgesic and total opioid consumption.
All patients were informed with the procedure and were trained to use the visual analogue scale (VAS).
The study was conducted on 60 randomly chosen patients aged 18 to 70 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each:
QL block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by mid-axillary approach under ultrasound guidance at the end of the operation. (QLB 2)
Intraperitoneal and periportal infiltration Group: received general anesthesia and 20 ml of 0.5% bupivacaine was injected under the direct vision into the hepato-diaphragmatic space, near and above the hepato-duodenal ligament and above the gall bladder before removal of the probes, also 10ml of 0.25% bupivacaine was injected at the port sites at the end of operation.
The two groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides recording time for first analgesic need and total consumption of pethidine in the 1st 24 postoperative hours. Post-operative hemodynamics and complications were also assessed.
The results of the study revealed that the Patients receiving QLB had significantly longer time to first rescue analgesic and significantly lower total opioid consumption in first 24 h post operative compared with patients who received Intraperitoneal and periportal infiltration.