Acute appendicitis develops in a progressive and irreversible manner, even if the
clinical course of acute appendicitis can be temporarily modified by intentional
medications. Reliable and real-time diagnosis of acute appendicitis can be made based on
findings of the white blood cell count and enhanced computed tomography. Emergent
laparoscopic appendectomy is considered as the first therapeutic choice for Acute
appendicitis .
The reported advantages of laparoscopic appendectomy compared with open appendectomy are
less postoperative pain, less wound infection, and better cosmetic results. Even though
the laparoscopic technique is minimally invasive, postoperative pain is inevitable.
Furthermore, it may affect the patients' mobility and cause them to stay in the hospital
for a more extended period .An intraperitoneal injection of local anesthetics is one of
the analgesic modalities that are used to control pain in such cases but it is
insufficient analgesic in most of patients and has short duration effect .
Recently Ultrasound-guided nerve blocks were effectively used for postoperative analgesia
in different types of surgical procedures .Both erector spinae plane block and oblique
subcostal transversus abdominis plane block have been used effectively to reduce pain
after laparoscopic appendectomy.
In ultrasound-guided Transversus Abdominis Plane (TAP) Block local anesthetic (LA) is
deposited in the plane between the transversus abdominis and posterior sheath of the
rectus muscle in approximately midway between the iliac crest and costal margin .To
anesthetize The terminal branches of the lower six thoracic and first lumbar nerve lie
within, providing analgesia of the anterior and lateral abdominal wall .This block has a
low risk for serious complications such as bowel or diaphragm perforation and lacerations
of the liver. Abdominal wall hematoma, vascular injury, and local anesthetic toxicity are
also potential but rare complications . Owing to safety of ultrasound-guided needle
placement a 'real-time' visualization through dynamic scanning is used .
The ultrasound-guided Erector Spinae Plane (ESP) block is a paraspinal fascial plane
block in which local anesthetic is administered between the erector spinae muscle and the
thoracic transverse processes at the levels of the T7-T9 transverse processes, resulting
in spread between the T6 and T12 segmental levels, blocking the dorsal and ventral rami
of the abdominal spinal nerves.
This blockage of the dorsal and ventral rami of the spinal nerves helps to achieve a
multi-dermatomal sensory block of the anterior, posterior, and lateral abdominal walls.
ESP block Complications such as vascular puncture, pleural puncture and pneumothorax are
the primary complications .Also local anethetic toxicity, infection at needle insertion
site and allergy also can occur .