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.

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Background: Bladder cancer is common in geriatrics who have high operative risk and less tolerability to surgical stresses. This study aims at comparing epidural versus continuous spinal anesthesia for elderly patients undergoing radical cystectomy regarding hemodynamics, total volume of bupivacaine used, patient's and surgeon's satisfactions and incidence of complications. Patient and Methods: Twenty male patients divided into 2 equal groups. Group I received continuous epidural anesthesia, 1-1.5 ml/segment of isobaric bupivacaine 0.5%+25µg fentanyl were injected to achieve T4 block then maintenance by 5 ml/h of isobaric bupivacaine 0.5% after 2 segment regression. Group II received continuous spinal anesthesia, 7.5 mg hyperbaric bupivacaine 0.5%+25µg fentanyl were injected. If T4 block wasn't achieved after 15 minute, 2.5 mg of hyperbaric bupivacaine 0.5% was given also during surgery 2.5 mg of hyperbaric bupivacaine 0.5% was given after 2 segment regression to maintain T4 block. Results: Mean age of both groups was comparable. Heart rate showed a significant decrease at 15 minutes after local anesthetics injection in group II (69.90±5.45 vs 76.70±4.97), while no significant differences were recorded later. Group I showed a statistically significant decrease in MAP in mmHg at 10 min (71.93 vs 92.63), at 35 min (65.07 vs 87.83), at 135 min (71.47 vs 84.00), and at 255 min (69.63 vs 80.23). Total dose of bupivacaine was significant smaller in the group II (44.45±4.34mg versus 260.00±21.08mg). Conclusion: Continuous spinal anesthesia has advantage of more hemodynamic stability with adjustable lower dose of injected local anesthetic and excellent patients' and surgeons' satisfaction.

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