post operative nausea and vomiting are very common after tympanomastoid operations, in this study we are investigating the effect of superficial cervical plexus block on the incidence and severity of those post operative complications.

various treatments and regimens have been tried to overcome the problem of postoperative nausea and vomiting after tympanomastoid surgery. superficial cervical plexus block seems so promising in this regards as it may reduce the incidence and severity of PONV through 3 mechanisms: primarily through blocking vagal afferents to the middle ear which mediate the vomiting reflex, and secondarily through decreasing pain which aggravates PONV, and finally through decreasing intra and post operative opioid consumption due to adequate analgesia which in turn avoids opioids side effects including PONV.

the study group will receive superficial cervical plexus block while the control will receive the same block while given placebo instead of (lidocain/bupivacaine mixture) incidence and severity of PONV will be recoded according to a scale to find the difference between both groups.

Inclusion Criteria:

• Patients belonging to American Society of Anesthesiologists physical status I-II.
• operation time less than 4 hours.

Exclusion Criteria:

• • American Society of Anesthesiology (ASA) physical status ≥ III.

  • Uncooperative or mentally retarded patients.
  • Known Allergy or hypersensitivity to lidocaine or bupivacaine.
  • Patients known to have gastritis or Gastro-oesophageal reflux disease (GERD).
  • History of PONV or motion sickness.
  • Operation duration (short less than 30 minutes or prolonged more than 240 min).
  • Patients with chronic renal disease (serum creatinine level ≥2.0mg/dl) or on renal replacement therapy (dialysis).
  • Patients with chronic cholecystitis (history of recurrent or persistent vomiting)
  • Skin inflammation and cellulitis.