Ultrasound guided transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block for analgesia after caesarean surgery which is performed under general anesthesia.

INTERVENTION: Comparison of Ultrasound guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block for pain relief after caesarean surgery which is perforemed under general anesthesia. Equipment Ultrasound – linear array probe 22G 100mm Stimuplex needle Study drug – 0.3ml/kg 0.25% bupivacaine Betadine antiseptic for skin preparation Standard monitoring and resuscitation equipment Patient controled analgesia device All patients will receive standard premedication, monitoring and anesthesia care. Adequate preparations will be made for the possibility of difficult airway. Propofol 2‐3 mg/kg iv and rocuronium 1 mg/kg iv will be used for induction of anesthesia. All patients will recieve fentanyl 1.5 mcg/kg iv and tenoxicam 20 mg iv After the completion of the surgical procedure one of the analgesia methods used for postoperative analgesia will be performed. TAP block technique The patient is in the supine position. Ultrasound will be positioned in the mid axillary line in the axial plane half way between the iliac crest and the costal margin. Structures to be identified: subcutaneous fat, external oblique muscle, internal oblique muscle, transversus abdominis muscle, peritoneum and intraperitoneal structures. The needle is inserted 'in plane' and directed to lie between the internal oblique and transversus abdominis under ultrasound guidance. To confirm location, 2ml of local anaesthetic can be injected. Patient will receive 0.3ml/kg 0.25% bupivacaine on each side QL block technique The patient is in the supine position. Ultrasound positioned in the mid axillary line in the axial plane half way between the iliac crest and the costal margin. Probe will be moved posteriorly until the QL muscle is confirmed . The needle tip will be placed at the anterolateral border of the QL at its junction of QL with transversalis fascia, and the local anesthetic will be injected. Patient will receive 0.3ml/kg 0.25% bupivacaine on each side CONDITION: Caesarean surgery Postoperative pain PRIMARY OUTCOME: Total cumulative opioid consumption in Patient Controlled Analgesia Device SECONDARY OUTCOME: Severity of postoperative pain via visual analogue pain scale (VAS) INCLUSION CRITERIA: Elective caesarean sections ASA 1 to 2 performed under general anesthesia Written informed consent.