الفهرس 
Pathophysiology of PainOnly 14 pages are availabe for public view
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Abstract
Introduction: A major contributor to the pain experienced after abdominal surgery is pain from the incision made in the abdominal wall, with the remainder resulting from internal visceral trauma. Traditionally, analgesia for abdominal surgery is provided either by systemic drugs such as opioids, ketamine, nonsteroidal anti-inflammatory drugs (NSAIDs), alpha-2 agonists and paracetamol, or by lumbar epidural anaesthesia (using mixture of local anaesthesia, opioids or other adjuvants). Peripheral nerve blockade is an alternative means of providing analgesia, by anaesthetizing the sensory nerves conveying pain impulses from the incision site to the spinal cord and brain. Aim: The aim of this work is to study the analgesic efficacy (including morphine consumption at 24 hours postoperative, cortisol level) of bilateral ultrasound guided continuous Transversus Abdominis Plane (TAP) Block compared with lumbar epidural block after radical cystectomy surgery. Patients: Forty patients, ranging in age from 21 to 65 yr, scheduled for elective radical cystectomy surgeries will be randomized using a random number table and the use of a closed envelopes technique to receive either combined General anesthesia and TAP (Transversus Abdominus Plane) block (group TAP) or combined general lumbar epidural anesthesia (group EA), Each group constitute of 20 patients (n=20). Methods: patients received lumbar epidural catheter will be placed between L3&L4 and an initial dose with 8ml of bupivacaine 0.25 % and 50μg fentanyl will be injected before induction of general anesthesia. The lumbar epidural analgesia will be maintained with 6-10 ml /hour by 0.125% bupivacaine and 2μg/mL fentanyl during the surgery; group Epidural(EA) or bilateral ultrasound guided TAP block will be performed after induction of general anesthesia using 20 ml of 0.25% bupivacaine in each side group (TAP). The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response. Results: The effect of the lumbar epidural anesthesia and transversus abdominis plane block in preventing the variability in the hemodynamic status postoperatively was the result of reduction in the incidence and severity of postoperative pain (VAS at rest and movement), thus causing reduction in the incidence and severity of sedation. Serum cortisol levels were elevated post-surgery in all patients. This elevation is in accordance with the well-estabished stress response to surgery. Further-more cortisol levels were significantly less elevated in the epidural group, compared to the TAP group throughout the postoperative observation period. Patients of the epidural group experienced less sever postoperative pain, also exhibited less serum cortisol level.