Background: The study was done to assess the postoperative analgesic efficacy\nof ultrasound-guided continuous transverses abdominis plane block,\ncontinuous lumbar paravertebral block and a continuous lumbar epidural\nblock in patients undergoing lower abdominal surgeries (unilateral inguinal\nhernia repair). We compared their analgesic efficacy over the first 48 hour\npostoperative, in a randomized, single-blind study in 120 patients divided into\nfour equal groups, 30 patients in each group. Methods: 120 patients randomly\nassigned into four equal groups, with 30 patients in each group. Group\nT received ultrasound-guided transverses abdominis plane block with 20 ml\nof bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125%\n(0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar\nparavertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by\ncontinuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received\ncontinuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml,\nfollowed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and\ngroup C received normal saline bolus dose 20 ml, followed by continuous infusion\nof normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl\n1 - 2 ---g/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg.\nAt the end of the surgical procedure, we activated the regional block with recording\nof parameters in the postoperative period each patient was assessed\nfor visual analog scale (VAS) at rest and on movement, analgesic consumption,\nvital signs and presence of complications (nausea, vomiting, sedation),\nand postoperative patient satisfaction all data collected postoperatively by a\nblinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results:\nPostoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative\nanalgesic consumption is lower than in group P and group T, regarding\ncomplications as nausea and vomiting more recorded in epidural\nthan the other two groups. Conclusion: Regarding postoperative analgesic\nefficacy, the continuous lumbar epidural block is more effective than continuous\nparavertebral and continuous transverses abdominis plane block, but\nregarding complications, there was a higher incidence in epidural group than\nother two groups.
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