الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 120 |  |  |
| | | from | 120 | | |
Abstract
Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility.
Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures.
ESPB is a new technique for providing postoperative analgesia after urologic surgeries with lumbar incision that relies upon injecting local anesthetic under the erector spinae muscle and into the interfacial plane between this muscle and the transverse processes so it is devoid of major adverse effects like pneumothorax, spinal cord trauma.
The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA.
The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent.
It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy.
Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria.
group A (n=30) : will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision.
group B (n=30) : will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery
The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake.