Cesarean Section, Pain Management, Neuropathic Pain
Conditions
Keywords
acute pain, transversus abdominis plane block, quadratus lumborum block, neuropathic pain
Brief summary
Comparison of two types of analgesia after cesarean section. All patients will anaesthetised with spinal technique. Ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will measured with visual-analogue scale (VAS). 1, 2, 6 months after surgery each patient will be called to assess neuropathic pain with Neuropathic Pain Symptom Inventory (NPSI).
Detailed description
Written consent will be obtained before the cesarean section. Only subarachnoidally anaesthetised patients may participate in the study. Pencil-point spinal needle and bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used. At the end of surgery ultrasound-guided regional block will be performed. Each patient will be randomly allocated to one of the treated group: transversus abdominis plane block (TAP) or quadratus lumborum (QL). Patients receive 0.2 mL of local anesthetic solution (0.25 % bupivacaine) on each side. Postoperative pain will be measured with VAS (visual-analogue scale) 2, 4, 8, 12 and 24 hours after the end of operation. Paracetamol, metamizol, ketoprofen may be given as required. Whenever pain exceeds 40 (VAS) 5 mg of morphine will be given intravenously (maximum two dosages per day). 1, 3, 6 months patients will be called to assess neuropathic pain. Neuropathic Pain Symptom Inventory (NPSI) will be used.
Interventions
ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).
PROCEDUREQL (quadratus lumborum block)
ultrasound-guided regional block between abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).
DRUGBupivacaine
In both groups (TAP&QL) 0.25% bupivacaine will be given (0.2 mL/kg)
DEVICENeedle
Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study
DRUGParacetamol
Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day
DRUGMetamizol
Intravenous metamizol will be used (1.0 gram), up to 4 grams per day
DRUGKetoprofen
Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day
DRUGMorphine
Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day)
Sponsors
Michał Borys
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* obtained consent * singleton pregnancy * subarachnoid anaesthesia
Exclusion criteria
* coagulopathy * allergy to to local anesthetics * depression, antidepressant drugs treatment * epilepsy * usage of painkiller before surgery * addiction to alcohol or recreational drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain measured with VAS | up to 24 hours after surgery | Acute pain measured with VAS (visual-analogue scale). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neuropathic pain assessed with NPSI | 6 months from the surgery | Neuropathic pain occurrence with Neuropathic Pain Symptom Inventory (NPSI) |
Countries
Poland
Outcome results
None listed