الفهرس 
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Abstract
P
oorly 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 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 these 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 is to assess the analgesic efficacy and hemodynamic effects of bilateral ultrasound guided injection Transversus Abdominis Plane (TAP) Block compared with lumbar epidural block after lower abdominal surgery. Each of them combined with general anesthesia in patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy surgery.
The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each:
group TAP:
25 Patients of this group will receive bilateral ultrasound guided lateral approach TAP block at the end of surgery using 20 ml of 0.25% bupivacaine for each side with a maximum dose of (3mg/kg).
group EA:
25 Patients of this group will receive epidural analgesia through catheter injection using a single dose of 15ml of 0.25% bupivacaine and 100 mg MgSo4(1ml of 10% MgSo4)at the end of surgery for postperative pain relief.
In the post anesthesia care unit (PACU) for first hour and in ward afterwards , all patients will be assessed for presence and severity of pain at 1, 2, 4, 6, 8, 10 and 12 hours postoperatively or at any time patient suffers from pain with visual analog score and recording its value at any patient visit.
Pethidine 0.5 mg/kg is the rescue analgesic that will be given to any patient who will suffer pain with VAS more than 4.
The results of the study revealed that Lumber epidural showed the best response as regard pain control post operatively in 1st 4 hour with no statistical significance. Then TAB block shows more superior in analgesia starting from 6 hours postoperative than single shoot epidural with less overall rescue analgesia consumption and complications as hypotension and tachycardia.