Open surgery remains one of the approaches used for those patients requiring partial or radical nephrectomy and is associated with a high incidence of intense immediate postoperative pain (Gupta et al., 2013; Bravi et al., 2019).
Erector Spinae Plane block (ESPB) has grown as a standard analgesic approach for thoracic, abdominal, and extremities surgeries because of its speed, ease of execution, minimal risk of hypotension and safety for patients with coagulopathy. Although it is believed that the spinal neurons' ventral and dorsal rami are involved, the exact pathway is yet uncertain (Forero et al., 2016; Hamed et al., 2019).
Inclusion Criteria:
Inclusion criteria:
Exclusion criteria
QLB will be done for patients in the study group at the end of surgery , before recovery of the patient from anesthesia. All blocks will be performed by one anesthesiologist experienced in U/S block; the patient will be placed in the lateral decubitus position according to the selected site of surgical interven-tion. The low-frequency convex probe of Sonosite M Turbo ultrasonography (FUJIFILM Sonosite, Inc., 124 S. E. ABD ELLATIF AND S. M. ABDELNABY Bothell, WA, USA) will be positioned horizontally in the anterior axillary line halfway between the subcostal margin and iliac crest after sterilization of the skin and draping, to locate the triple abdominal muscle layers, then the probe will be relocated subsequently to the posterior axillary line until the quadratus lumborum muscle could be visualized with its attachment to the lateral edge of the transverse process of the L4 vertebral body, With the psoas major muscle places anteriorly, the erector spinae muscle posteriorly
• In ESPB group In the ESPB group the patient will be placed in the lateral decubitus position according to the selected site of surgical intervention. After sterilization and drapping of the skin of the upper back, counting down from seventh cervical vertebrae spine to identify the spine of the seventh thoracic vertebrae (T7). This will be related to the tip of the scapular spine. A high-frequency probe of Sonosite M Turbo ultrasonography (FUJIFILM sonosite, Inc., Bothell, WA, USA) will be placed across the T7 spine and the probe will be moved laterally to identify the trans-verse process of T7. Thereafter, the probe will be moved to a sagittal plane to visualize the erector spinae muscles lying underneath the trapezius muscle. A 22- gauge, 80 mm needle (Stimuplex D, B-Braun, Germany) will be inserted medially inplane relative to the ultrasound probe and directed towards the transverse process. Once the needle is underneath the anterior fascia of the erector spinae muscle, 1 ml
Cairo, Egypt
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