Ultrasound Guided Quadratus Lumborum Block Versus Laparoscopic Superior Hypogastric Plexus Block for Postoperative Analgesia After Laparoscopic Hysterectomy
Ultrasound Guided Quadratus Lumborum Block Versus Laparoscopic Superior Hypogastric Plexus Block for Postoperative Analgesia After Laparoscopic Hysterectomy
Pain following laparoscopic hysterectomy may interfere with early ambulation, discharge of patient from hospital and interfere with enhanced recovery with more opioid consumption. Most of methods for postoperative pain depend on the use of high doses of opioids with more side effects such as nausea, vomiting, respiratory center depression, delay bowel motility and hemodynamics instability. To decrease of opioid consumption in postoperative pain management as well as related side effects, previous studies showed that quadratus lumborum block or superior hypogastric plexus block (SHPB) had shown promising success in management of postoperative pain in patients undergoing laparoscopic hysterectomy. The present study will be conducted to compare of ultrasound guided QL block and laparoscopic superior hypogastric plexus block as a part of multimodal analgesia may allow adequate analgesia and decrease the overall use of opioids and allow patient enhanced recovery.
hypothesis: There is no difference between the analgesic effect of either Ultrasound guided QL block or laparoscopic Superior hypogastric plexus block on post laparoscopic hysterectomy pain.
Alternative hypothesis:
There is difference between the analgesic effect of either Ultrasound QL block or laparoscopic superior hypogastric plexus block on post laparoscopic hysterectomy pain.
Aim of the work Better achievement of effective analgesia with less opioid consumption and related side effects for post laparoscopic hysterectomy pain.
Objectives To assess effect of both ultrasound quadratus lumborum block and laparoscopic superior hypogastric plexus block on analgesic outcome (Visual Analogue Scale VAS, duration of analgesia) after laparoscopic hysterectomy. To compare between ultrasound quadratus lumborum block and laparoscopic superior hypogastric plexus block regarding to total opioid for postoperative analgesia after laparoscopic hysterectomy and patient satisfaction. To record side effects related to regional block ( e.g., local anesthetic toxicity, vascular and neural injury) and opioids ( neasuea, vomiting, respiratory depression
Inclusion Criteria:
1. Allergy to local anesthetics. 2. Infection at site of injection. 3. Patients with coagulopathy. 4. Patients with chronic pain syndromes. 5. Physical and mental disease which could interfere with pain scores evaluation.
6. Patients with distorted local anatomy.