Background and Aim: Intraperitoneal (IP) administration of local anesthetic is considered a method of control of visceral component of pain. This method cannot be used as sole agent for pain relief after laparoscopic cholecystectomy (LC). Transversus Abdominis Plane block (TAP) becomes a useful anesthetic technique in the treatment of postoperative pain after the LC surgery. The aim of the study was to compare between IP bupivacaine –Magnesiu;m Sulfate (MgSO4) and TAP by bupivacaine- MgSO4 for pain relief after LC. Materials and Methods: This was a randomized double blinded study on sixty patients ASA I &II, age from 18 to 60 years old, undergoing elective LC surgery were randomly classified into two equal groups (30 patients in each group). Group I: IP instillation of 30 ml [15 ml bupivacaine 0.5% (75mg) plus 2.5ml MgSO4 (250 mg) plus 12.5 normal saline].Group II: Ultrasound guided subcostal TAP block was performed by using total volume 20 ml on each side [10 ml bupivacaine %0.5 (50 mg) plus 1.5ml MgSO4 (150 mg) plus 8.5 normal saline]. Heart rate (HR) and Mean Arterial Blood Pressure (MAP) were measured at 5 min before induction and every 15min after induction till the end of operation and then every 5 min for the first 20 mins after administration of study drugs then they recorded at interval of 30mins, 1hr, 2hrs, 4hr and 6hr postoperative. Numeric Rating Scale (NRS) at emergence, 2, 4, 8, 12, 18 and 24hr after recovery, first rescue analgesia time, postoperative analgesic consumption, length of hospital stay(LOS), patients’ satisfaction and post-operative complications were recorded. Results: There were insignificant differences in HR and MAP between the two groups. There was a significant decrease in NRS at 4hr and 8 hr in group II than group I. There was a significant decrease regarding to time of first rescue analgesia, total postoperative analgesic consumption and LOS in group II compared to group I. There was a significant increase of satisfaction in group II compared to group I. There was an insignificant difference between both groups in nausea, vomiting, hypotension, bradycardia, bradypnea or MgSO4 toxicity. Conclusion: TAP by bupivacaine-MgSO4 has superior analgesia, longer duration, less postoperative analgesic consumption and more satisfaction in patients undergoing LC than IP block by bupivacaine-MgSO4.
Background: Peripheral nerve block may provide effective unilateral postoperative analgesia following knee and hip surgeries with a lower incidence of opioid-related and autonomic side-effects, less motor block. Fascia iliaca block (FIB) and adductor canal block (ACB) have been shown to be a successful technique for postoperative pain relief after knee surgeries. The aim of our study was to compare the effect of ultrasound guided FIB versus ultrasound guided ACB for postoperative analgesia in patients undergoing knee surgeries. Methods: Our randomized controlled trial was conducted over 105 patients aged between 18 and 65 years, (ASA) class I and II undergoing knee surgeries. Patients divided into three groups: Group I control (C): Patients received spinal anesthesia alone. Group II (FIB): Patients received spinal anesthesia with postoperative ultrasound guided FIB. Group III (ACB): Patients received spinal anesthesia with postoperative ultrasound guided ACB. Results: Both FIB and ACB provided better pain control compared to control group. The need for first dose of supplemental analgesic was earlier in the control group than FIB and ACB groups postoperatively. Additionally, the total 24-h pethidine consumption was highest in the control group compared to fascia FIB and ACB groups. FIB was shown to reduce the strength of the quadriceps muscle, which resulted in delayed early postoperative mobilization and influencing patient satisfaction. There was statistically significant increase in heart rate and mean arterial blood pressure in group I as compared to group II and group III at 6hrs and 12hrs postoperatively. Conclusions: Both FIB and ACB provide excellent postoperative analgesia after knee surgeries, however the ACB is superior to FIB because it has no prolonged muscle weakness and FIB did.
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