Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Background:Abdominal surgeries have been shifted from open surgeries to laparoscopic techniques in the last few decades.This, led to development of new local or regional analgesic techniques for postoperative pain control. Objectives:To compare between the efficacy of ultrasound guided transversus abdominis plane block (TAP) and erector spinae plane block (ESP) with dexmedetomidine as an adjuvant to local anesthetic for postoperative pain relief in adult patients scheduled for upper abdominal surgeries . Patients and methods: The study compared four groups of patients who underwent upper abdominal procedures.In the first group,an ultrasound-guided TAP block was performed posterior to the mid-axillary line with 20 ml of 0.25% bupivacaine on each side. In the second group,an ultrasound-guided ES block was performed at T7 level with 20 ml of 0.25% bupivacaine on each side. In the third group, an ultrasound-guided TAP block was performed posterior to the mid-axillary line with 20 ml of 0.25% bupivacaine and 1 μg/kg dexmedetomidine on each side. Results: The groups B and D showed significantly shorter anesthetic and mobilization times compared to the other groups, despite not significantly different demographic data,duration of surgey, and incidence of complications. However,group D had a noticeably lower visual analogue scale and plolonged first analgesic request, indicating a potential difference in patient outcomes. Conclusion:Compared to the TAP block,the ESP block has more analgesic,provides longer-lasting postoperative pain relief, delays the time to initial necessity for analgesia, provide early mobilization and minimizes opioid intake;hence,it may be employed in multimodal analgesia and opioid sparing regimes after upper abdominal procedures.