الفهرس 
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Abstract
Introduction The quality of recovery after major surgical procedures depends on various factors, prominent among them being the quality of hemodynamic conditions, as well as minimal anti-nociceptive associated side effects. Aim of the work The purpose of this study was to evaluate the quality of analgesia and the incidence of adverse effects of intravenous patient controlled analgesia with intercostal nerve blockade versus patient-controlled epidural analgesia in patients undergoing major upper abdominal surgery under general anesthesia. Patients and Methods Patients were allocated into three groups (forty patients each) to receive: patient-controlled epidural analgesia with morphine (PCEA group), intercostal nerve blockade associated with patient controlled intravenous analgesia with morphine (INB-PCA group) or intercostal nerve blockade only (INB group). Results At rest, analgesia was satisfactory in the three groups during the first 12hr post-operatively (VAS pain score ≤ 2) VAS pain score of the INB-PCA group was significantly lower than the other two groups. After the 1st 12h, VAS pain score was significant lower in the 1st group compared to the other two groups (VAS pain score ≤ 2). VAS pain score of patients of the 2nd group was significantly lower than the 3rd group. During activity, patients of the 2nd group experienced better analgesia compared to PCEA & INB groups during the first 12hr post-operatively. However, after the first 12hr, analgesia was satisfactory in (PCEA) group compared to the other two groups (VAS pain score ≤3). VAS pain score of the 2nd group was significantly lower than the 3rd group. Conclusion Intercostal nerve block was effective during the first 12 hr. Pain control was significantly better achieved by the IV-PCA use of morphine. INB and IV-PCA may be considered as a good alternative therapy of epidural analgesia.