Cesarean Section, Postoperative Pain
Conditions
Keywords
transversus abdominis plane block, quadratus lumborum block, neuropathic pain
Brief summary
Comparison of two types of analgesia after cesarean section All patients will be anesthetized with spinal technique. Ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will be measured with visual-analog 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 anesthetized 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 (0.375 % ropivacaine) on each side. Postoperative pain will be measured with VAS (visual-analog scale) 2, 4, 8, 12 and 24 hours after the end of the operation. Paracetamol, metamizole, 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
the ultrasound-guided regional block of abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375% ropivacaine administered (0.2 mL/kg).
PROCEDUREQL (quadratus lumborum block)
the ultrasound-guided regional block of abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with a distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).
DRUGRopivacaine
In both groups (TAP&QLB) 0.375% ropivacaine 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
DRUGmetamizole
Intravenous metamizole 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
Medical University of Lublin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Single (Participant)
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* obtained consent * singleton pregnancy * subarachnoid anesthesia
Exclusion criteria
* coagulopathy * allergy 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 | up to 24 hours after the surgery | Acute pain measured with VAS (visual-analogue scale). VAS in milimmeters. Minimum value 0, maximum 100. Less better - less severe pain. 0 no pain at all. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neuropathic pain | 6 months from the surgery | Neuropathic pain occurrence assessed with Neuropathic Pain Symptom Inventory (NPSI) 10 descriptive variables, each one from 0 to 10. 0 means no pain. 10 very high chance of occurrence of neuropathic pain. |
Countries
Poland
Outcome results
None listed