Cesarean Section, Pain, Postoperative, Pain, Neuropathic
Conditions
Keywords
postoperative pain, transversus abdominis plane block, quadratus lumborum block, neuropathic pain
Brief summary
All patients will be anaesthetized with spinal technique. Each patient will be treated with intravenous morphine - patient controlled analgesia (PCA). 2 of 3 groups of patients will receive ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will measured with visual-analogue scale (VAS). Total morphine consumption and time to the first demand will be noted. 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. All patients will receive PCA (patient controlled analgesia) pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit). In PACU vital signs will be monitored. Each patient will be randomly assigned to one of three groups. In the first group of patients no additional regional analgesia will be performed. In the second and the third group, ultrasound-guided transversus abdominis plane or quadratus lumborum block will be done with 0.375 % ropivacaine (0.2 ml per kg 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. 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
PROCEDUREQLB (quadratus lumborum block)
ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain
DEVICEStimuplex Ultra 360 needle
ultrasound-guided needle will be used for QLB and TAP and regional blocks
DRUGRopivacaine
0.375 % ropivacaine will be administered for both QLB and TAP (0.2 mL per kg on both sides)
DRUGParacetamol
Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day
PROCEDUREsubarachnoid anesthesia
subarachnoid anesthesia for each patients participating in the study with pencil point needle
PROCEDUREPCA (patient controlled analgesia)
All patients will receive PCA pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit)
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
DRUGBupivacaine
Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY)
Sponsors
Medical University of Lublin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
Participants, care providers, and assessors were not aware of type of the block
Intervention model description
Participants were randomized 1:1:1
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 morphine and 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) |
| Morphine consumption | up to 24 hours after surgery | Total morphine consumption |
Countries
Poland
Outcome results
None listed