Background: Systemic analgesics should be used carefully when treating patients following renal surgery since these patients often have compromised renal function. Therefore, in such individuals, the localized nerve block may be a useful choice. This study's objective was to assess the effectiveness of transmuscular and anterior subcostal QLBs as a secure substitute for thoracic paravertebral blocks guided by ultrasonography for treating immediate postoperative pain in patients having open kidney operations. Methods: This prospective randomized double blinded study was carried out on 54 adult patients who underwent elective open renal surgeries. Patients were randomly classified into three equal groups, all were guided by ultrasonography: Group I: Transmuscular QLB, group II: Anterior Subcostal Quadratus Lumborum (ASQL) Block, and group III: Thoracic Paravertebral (TPV) Block. Results: Regarding the beginning of sensory block, overall intraoperative fentanyl usage, period to first rescue analgesic demand, and overall morphine consumption, there was a substantially significant difference between the three groups (P-value <0.001). VAS revealed a substantial difference between the three groups (P<0.001) at T0 before discharging from PACU, 2, 4 and 6 hours. There was statistically significant increase in patients’ satisfaction in group II&III compared to group I where (P =0.03). Conclusions: Ultrasound-guided anterior subcostal QLB produced safe and adequate analgesia during and after open renal surgeries that was comparable to thoracic paravertebral block, but the transmuscular QLB failed to provide adequate analgesia compared to anterior subcostal QLB and thoracic paravertebral block.

Background: Maintaining satisfactory ventilation for obese patients undergoing bariatric surgery frequently poses a challenge for anesthetists. The optimal ventilation strategy during pneumoperitoneum remains obscure in obese patients. In this study, we investigated the effect of conventional ventilation, inverse ratio ventilation (IRV) and alveolar recruitment maneuver (RM) on arterial oxygenation, lung mechanics and hemodynamics in morbid obese patients undergoing laparoscopic bariatric surgery. Methods: 105 adult obese patients scheduled for elective laparoscopic bariatric surgery were randomly allocated into three groups: Conventional ratio ventilation (I:E ratio was 1:2, PEEP 5 cmH2O and no RM), Inverse Ratio Group (IRVG) (I:E ratio was 2:1 and PEEP 5 cmH2O and No RM ) and Recruitment Maneuver Group (RMG) ( RM was done and I:E ratio was 1:2). Arterial blood gases and respiratory mechanics were recorded after induction of anesthesia (T1), 5 minutes (T2), 30 minutes (T3), 60 minutes (T4) after the beginning of pneumoperitoneum and at the end of the surgery (T5).  Cardiac output was recorded at (T1), (T2), (T3) and (T5). Results: At T3, T4 and T5, arterial oxygen tension was higher in RMG than IRVG than CG (P ˂ 0.05). At T3, T4 and T5, the mean airway pressure and dynamic compliance (Cdyn) were significantly higher in IRVG and RMG compared with CG (P ˂ 0.05) while at those times, the mean air way pressure and Cdyn in IRVG and RMG were comparable. Cardiac output result were comparable between all groups throughout the study period (P ˃ 0.05). Conclusions: RM and IRV had provided better arterial oxygenation and respiratory mechanics compared to conventional ventilation in morbid obese patients undergoing laparoscopic bariatric surgery. However, RM had better gas exchange than IRV.