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Background: Ultrasound (US)-guided transmuscular quadratus lumborum (TQL) block and oblique subcostal transversus abdominis plane (OSTAP) block are components of multimodal analgesia for abdominal surgeries. The aim of the study is to compare the analgesic efficacy of US-guided TQL block versus US-guided OSTAP block after upper abdominal surgeries. Methods: This prospective randomized study was conducted on 40 patients scheduled for elective open upper abdominal surgery under general anesthesia. Patients were randomly allocated into 2 groups; OSTAP Group (20 patients) received US-guided OSTAP block, and TQL Group (20 patients) received USguided TQL block. At the end of surgical procedure, while patients were still under general anesthesia, each group received 30 mL bupivacaine 0.25%. Postoperative measurements included pain scores, time to first opioid analgesic request, postoperative total opioid consumption, patient satisfaction, and complications. Results: Patients of TQL group had statistically significant lower 24 h postoperative total morphine consumption than patients of OSTAP group (13.25±2.88 mg and 20.10±3.21 mg, respectively, P < 0.001), and longer time to first opioid analgesic request (337.52±18.37 min. and 242.35±11.20 min., respectively, P < 0.001). Patients received TQL block had also statistically significant lower postoperative pain scores, less frequent morphine doses, and more patient satisfaction. Conclusion: US-guided TQL block is more effective postoperative analgesic modality than US-guided OSTAP block in patients undergoing elective open upper abdominal surgery under general anesthesia.

Background: Invention of the endotracheal tube made administration of anesthesia easy. However, laryngoscopic stimulation of oropharyngolaryngeal structures is associated with hemodynamic stress response. Recently, the I-gel has been invented. It is a new 2nd generation supraglottic airway device with a non-inflatable cuff which has several potential advantages including: easier insertion, minimal risk of tissue compression and stability after insertion. Objective: The aim of this study was to compare the I-gel to the cuffed endotracheal tube in laparoscopic surgeries in adult patients. Patients and Methods: A prospective randomized controlled clinical trial among 80 patients who underwent laparoscopic procedures. They were equally divided into two groups: I-gel and cuffed endotracheal tube (ETT) groups. Both the devices were compared as regards insertion characteristics, hemodynamic stability, gas exchange parameters, peak airway pressure changes and the incidence of postoperative complications. Results: No significant statistical difference between the two groups was found regarding heart rate, O 2 saturation, end tidal CO 2 and peak airway pressure changes. Regarding mean arterial blood pressure, it was more stable after insertion in the I-gel group (P=0.019). There was also significant difference in the insertion time (P=0.0029) and number of insertion attempts (P=0.04) between the two groups. Regarding ease of insertion of gastric tube, it was easier to be inserted in the ETT group (P=0.0001). The postoperative complications were higher in the ETT group; for dysphagia (P=0.0002), dysphonia (P=0.0007), nausea (P=0.0019), vomiting (P=0.00017). However, there was no difference in the presence of blood on the device (P=0.396). Conclusion: I-gel is a safe airway device during the laparoscopic procedures. It was better than the cuffed ETT regarding hemodynamic stability changes after insertion without affecting gas exchange parameters. Although the complications were higher in the ETT group but the gastric tube insertion was more difficult in the I-gel group.

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