This study aims to evaluate the safety and efficacy of combined subcostal and lateral transversus abdominis plane (TAP) for postoperative analgesia versus thoracic epidural anesthesia (TEA) in patients undergoing major abdominal cancer surgery.
Age ≥ 18 years.
Both sexes.
American Society of Anesthesiologists (ASA) physical status I-III.
Scheduled for major abdominal surgeries including: (e.g., gastrectomy, colectomy, hepatectomy, cystectomy, total abdominal hysterectomy, Nephrectomy, pancreatectomy).
Intraoperative hemodynamic instability.
History or evidence of coagulopathy.
Infection or abdominal wall masses at injection site.
Morbid obesity.
Parallel
Subcostal and lateral transversus abdominis plane block
Other interventionPatients will receive an ultrasound-guided combined subcostal and lateral transversus abdominis plane block.
Thoracic epidural anesthesia
Other interventionPatients will receive an ultrasound-guided thoracic epidural anesthesia.
Total morphine consumption
Rescue analgesia of morphine will be given as 3 mg bolus if the Visual Analogue Scale (VAS) \> 3 to be repeated after 30 min if pain persists until the VAS \< 4.
Time to the 1st rescue analgesia
Time to the first request for the rescue analgesia (time from the end of surgery to first dose of morphine administrated).
Mean arterial pressure
Mean arterial pressure will be recorded before skin incision, one minute after skin incision and then recorded regularly every 10 minutes.
Heart rate
Heart rate will be recorded before skin incision, one minute after skin incision and then recorded regularly every 10 minutes.
Degree of pain
Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed at 0, 4, 6, 8, 12, and 24 h postoperatively.
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