الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia.
Regional anesthesia techniques like TAP block are a well suited techniques for minimizing the incidence of post operative pain, reducing the need of high dosage intra operative and post operative analgesia, although local anesthetics alone can achieve satisfactory response, it had been found that addition of many adjuvant as clonidine, ketamine, opiods like Fentanyl, magnesium, dexmedetomidine and dexamethazone can improve the onset and the duration of the sensory and the motor block provided by regional anesthesia.
The introduction of ultrasound technique in regional anesthesia like TAP block provided both increased successful dense block to neural structures, also minimizing the incidence of complications or failure of the block.
Fentanyl is similar to other opioid drugs, it target opioid receptors being selective on MU receptors, (mu selective agonist) but it also can act on other opioid receptors like kappa and delta. This interaction with the opioid receptors especially the Mu receptors produce its analgesic effect with subsequent increase of neurotransmitter dopamine in the brain reward centers.
The aim of this study was to study the effect of Fentanyl as an adjuvant to bupivacaine in TAP block for postoperative analgesia after appendectomy. The comparison included the onset and the duration of the sensory block, the duration of analgesia of the block as well as their effects on the postoperative opiod analgesic requirements. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done.
In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only while the fentanyl group in which 50 ug of fentanyl were added to bupivacaine. All patients received equal volumes. Our study showed that addition of a 50 microgram of fentanyl to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the onset of sensory block and prolonged the duration of the sensory block. In addition, fentanyl prolonged the duration of analgesia significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of fentanyl also did not affect the hemodynamics to a significant level. This makes fentanyl with bupivacaine more superior than the use of bupivacaine alone.