الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
we compared between bilateral ultrasound-guided rectus sheath (group R), bilateral subcostal transvesus abdominis plane (groupT) and bilateral posterior quadratus lumborum (group Q) blocks with 20 ml bupivacaine 0.25% in patients undergoing laparoscopic cholecystectomy for producing adequate intraoperative and postoperative analgesia. Patients were chosen with ASA I or II physical status between 18 and 60 years old. The primary outcome measures were time for the first request to rescue analgesia (when VAS is 4 or more), the severity of postoperative pain (measured by using the visual analogue scale (VAS) for pain, where 0 is equal to no pain and 10 indicates the worst possible pain) and total amount of postoperative ketorolac consumption for 24 hours after surgery. The secondary outcome measures were total amount of intraoperative fentanyl consumption, effects on hemodynamics, number of patients needed ephedrine and/or atropine and occurrence of complications. Time of first analgesic requirement was significantly longer in Q group (10.1±0.9)hr than T (7.1±0.6)hr and R(3.2±0.4)hr groups and significantly longer in T group than R group. Ketolac requirement as rescue analgesia was significantly lower in Q group (10.5±14.6)mg than T (19.5±14.6)mg and R (52.5±13.3)mg groups and significantly lower in T group than R group.
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Summary
The study measured and compared intraoperative hemodynamics in the form of heart rate and mean arterial blood pressure. The measurements in Q group were significantly lower than in T group at 60 minutes after induction and all through, and those in T group were significantly lower than in R group at 45minutes after induction and all through, which demonstrated that QLB was the most effective analgesic modality, and that subcostal TAP block was more effective than Rectus sheath block. So ephedrine use in Q(mean=7.6±2.7 mg) and T(mean=6mg) groups was significantly higher than R group(0mg). The study also measured and compared postoperative heart rate, mean arterial blood pressure in the first 24 hours after the operation. HR and MAP showed significant lower values in Q group than T and R groups and significant lower values in T group than R group(P3<0.05,P2<0.05,P!<0.05). Heart rate values in Q group were lower than T group without significance at 5,6,14,16 hours(P3>0.05). )). MAP values in Q group were lower than T group without significance at 7 hours(P3>0.05).MAp values in T group were lower than R group without significance at 0.5 ,1,1.5,2,3,4 hours(P1>0.05). This also demonstrated that QLB was the most effective analgesic modality, and that subcostal TAP block was more effective than Rectus sheath block. The QLB group also showed significantly lower consumption of fentanyl intraoperatively than rectus group(115±23.5 ug vs 135±23.5 ug) with no significance between quadratus and subcostal TAP groups (115±23.5 ug vs 122.5±25.5 ug) or between subcostal TAP and Rectus groups(122.5±25.5 ug vs 135±23.5 ug). Time needed to perform rectus sheath block (23±3.4 minutes) was significantiy lower than quadratus lumborum (43.9±2.6minutes) and subcostal TAP blocks (38.9±2.7 minutes). Also, time needed to perform
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Summary
subcostal TAP block was significantiy lower than quadratus lumborum block. Operative time showed no statistically significant difference between groups. Regarding the postoperative period, the VAS of Q group was significantly lower than R group till 24 hours. VAS of Q group was significantly lower than T group till 10 hours. VAS of T group was significantly lower than R group till 7 hours. As regard postoperative complications, only nausea occurred in 10 patients (1 in Q group, 2 in T group and 7 in R group) We conclded that QLB was the most effective technique in providing analgesia after laparoscopic cholecystectomy in comparison to subcostal TAP block and rectus sheath block.