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Background and Aim:Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects.Settings and Design:A prospective, randomized, controlled double-blind trial that was carried out at a university hospital.Patients and Methods:Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 μg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded.Statistical Analysis:Student's t-test, Mann–Whitney U-test, and Chi-square test were used.Results:Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10–19.50) mg compared to 25 (17.50–37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus.Conclusions:Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.

Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery. Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia. Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery. Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block. Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017

Background. Controlled ventilation for head trauma patients should reduce hypoxemia, hypercapnia and prevent secondary brain injury. However, changes in cardiac output and arterial blood pressure are the common consequences of mechanical ventilation. This study was designed to compare pressure-versus volume-controlled ventilation modes in severe head trauma patients to identify the mode with least hemodynamic compromise and best oxygenation profi le. Methods. This prospective crossover study was carried out on 15 severe head trauma patients admitted to surgical ICU for mechanical ventilation and critical care. All patients were initially ventilated with volume-controlled ventilation for 12 hours then the mode of ventilation was changed to pressure-controlled ventilation for the next 12 hours. Arterial and pulmonary artery catheters were inserted for continuous monitoring of arterial blood pressure, cardiac output, pulmonary artery pressure, pulmonary wedge pressure, pulmonary vascular resistance, and systemic vascular resistance every 4 hours from the start of each ventilation mode. Lung mechanics and arterial blood gases were simultaneously recorded during the times of hemodynamic monitoring. Results. Cardiac output did not show signifi cant changes between the 2 ventilation modes and mean group differences at 4, 8, and 12 hours were − 0.2, − 0.2, − 0.1 L/min (95% confi dence interval = − 1.04 to 0.64, − 0.92 to 0.52, and − 0.68 to 0.48 L/min), respectively. Additionally, the other hemodynamic variables were comparable at all levels of study analysis. Volume-controlled ventilation was associated with signifi cant higher peak air way pressure in comparison with pressure-controlled ventilation after 4, 8, and 12 hours. The oxygenation values and other lung mechanics were not signifi cantly change between the 2 ventilation modes. Conclusion. Both volume-controlled and pressure-controlled ventilations have comparable hemodynamic and oxygenation profi les in severe head trauma patients for short-term ventilation.