الفهرس 
Pain managementOnly 14 pages are availabe for public view
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Abstract
Inguinal hernia repair is a common surgical procedure performed in the pediatric age group and it is associated with considerable postoperative discomfort. Management of postoperative pain in pediatrics is a very important issue to decrease postoperative complications. There are many modalities for pain control in pediatrics including regional anesthesia, intravenous opioids and intravenous or rectal non-opioid drugs. Regional anesthesia is an important option in postoperative pain control as it provides effective and safe analgesia. The use of ultrasound as an aid for accurate placement of local anesthetic is gaining in popularity for regional anesthesia. The transversus abdominis plane (TAP) block is a regional anesthetic technique that involves the injection of local anesthetic (LA) into the plane between the transversus abdominis and the internal oblique muscles. It can be used in various anterior abdominal wall procedures as appendectomy, ventral hernia, inguinal hernia, and laparotomy. The erector spinae plane (ESP) block is a novel technique in which LA is deposited in the fascial plane deep to the erector spinae muscle and superficial to the tip of the transverse process. This study was carried out in Tanta university hospitals in the pediatric surgery department on 90 patients of both sexes aged from 2 to 7 years old with ASA physical status I and II for six months from August 2019 to January 2020 scheduled for elective laparoscopic unilateral inguinal hernia repair. Exclusion criteria include Patient’s parent’s refusal, History of allergy to local anesthetics, Patients with upper airway infection 2 weeks or less before surgery, History of developmental delay, mental retardation or CNS disease, Congenital spine anomaly, Local infection at the site of the block, Patients with bleeding and coagulation disorders and Patients with renal, hepatic, or cardiac dysfunction. All patient’s parents signed informed consent and the study was approved by the institutional ethical committee. Patients were randomly divided into three groups (30 patients each): 1. Control group ( group C): Consist of 30 patients who received general anesthesia alone. 2. TAP group (group T): Consist of 30 patients who received bilateral ultrasound-guided TAP block after induction of general anesthesia with injection of 0.4 ml/kg bupivacaine 0.25% 3. ESP group (groupE): Consist of 30 patients who received bilateral ultrasound-guided ESP block after induction of general anesthesia with injection of 0.4 ml/kg bupivacaine 0.25%. Recorded data included HR and non-invasive intraoperative MAP. Modified CHEOPS pain score, amount of fentanyl needed as rescue analgesia intra-operatively, amount, and the onset of fentanyl as rescue analgesia and incidence of complications. Our results showed no significant difference regarding demographic data between the three groups. In this study according to CHEOPS, we found no statistically significant difference between ESP and TAP groups but significant increase in the control group. also, There was a significant decrease in total rescue analgesia (intraoperative & postoperative ) in the T group and E as compared to group C. Also there was a significant delay in onset of first rescue analgesia post operatively between group T&E in comparison to group C. the mean value of heart rate between the 3 groups showed no statistically significant difference between TAP and ESP groups intra-operatively but significant increase in heart rate in the control group in all stages of the operation as compared to T& E groups. mean arterial blood pressure changes were insignificant between three groups in all stages of operation.