الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In recent years, awareness of the value of adequate postoperative pain relief has been increased and several methods have been introduced. An effective pain therapy to block or modify the physiologic responses to stress has become an essential component of modern paediatric anaesthesia.
Ultrasound guidance for regional anaesthesia is associated with higher block success rates, shorter onset times, and reduced total anaesthetic dose required and reduced complications. There is also the advantage of direct observation of the pattern of local anaesthetic spread.
Innervation of the anterolateral abdominal wall arises from the anterior rami of spinal nerves T7 to L1. Branches from the anterior rami include the intercostal nerves (T7-T11), the subcostal nerve (T12) and the iliohypogastric / ilioinguinal nerves (L1). Intercostal nerves T7 to T11 exit the intercostal spaces and run in the neurovascular plane between the internal oblique and the transversus abdominis muscles. The subcostal nerve (T12) and the ilioinguinal/iliohypogastric nerves (L1) also travel in the plane between the transversus abdominis and internal oblique, innervating both these muscles.
The transversus abdominis plane (TAP) block was first introduced by Rafiin 2001 as a landmark-guided technique via the triangle of Petit to achieve a field block. It involves the injection of a local anaesthetic solution into a plane between the internal oblique muscle and transversus abdominis muscle. Since the thoracolumbar nerves originating from the T6 to L1 spinal roots run into this plane and supply sensory nerves to the anterolateral abdominal wall, the local anaesthetic spread in this plane can block the neural afferents and provide analgesia to the anterolateral abdominal wall.
The quadratus lumborum (QL) block was first described by Blanco. Currently, the QL block is performed as one of the perioperative pain management procedures for all generations (pediatrics, pregnant, and adult) undergoing abdominal surgery.
The aim of the study was to compare between Quadratus lumborum (QL) and Transversus abdominal plane (TAP) blocks in paediatric patients undergoing minor lower abdominal surgeries as regards postoperative analgesic efficacy , and complications.
The study was carried out in Alexandria University Hospitals on 40 patients, aged 3 to 7 years, with American Society of Anesthesiologists (ASA) physical status scores of I and II, planned for minor lower abdominal surgery (e.g. Congenital inguinal hernia , hydrocele and hernia of canal of nuck) under general anaesthesia. This study was a randomized prospective double blinded clinical trial. The sample size was calculated by Community Medicine Department Alexandria University. Informed consent was taken from the parents.
Patients were assigned into two equal groups 20 each using closed envelope technique:
• group (I): received ultrasound guided transverses abdominus plane (TAP) block with 0.5 mL/kg 0.2% bupivacaine to be applied between the internal abdominal oblique and the transverses abdominis muscles.
• group (II): received ultrasound guided quadrates lumborum block (QL) (anterior approach) using 0.5 mL/kg 0.2% bupivacaine to be applied between the QL muscles and psoas major muscle at the thoracolumbar fascia..
All the patients were assessed pre-operatively by detailed history taking, complete clinical examination and routine laboratory investigations.
All patients were premedicated with oral midazolam 0.5 mg/kg.
In the operation room, electrocardiography, noninvasive blood pressure, and peripheral oxygen saturation were monitored General anesthesia was induced with sevoflurane and 50% air in oxygen then IV access was inserted. Fentanyl was administered at 1 μg/kg, and a laryngeal mask airway was used to secure the upper airway. Anaesthesia was maintained with sevoflurane 2% and 50% air in oxygen.
All blocks (TAP, QL) were performed by the same anaesthetist after placement of a laryngeal mask airway before surgery