Regional Block
Conditions
Brief summary
This patient population are at risk of adverse effects secondary to inadequate pain management such as inadequate maternal bonding and late ambulation. Regional analgesia is preferred due to their opioid sparing effects and reduction in related adverse effects but the analgesia from these blocks is not known which one is superior to the other in the context of cesarean section
Detailed description
The aim of this study is to compare the effect of posterior transversus abdominus plane block and quadratus lumborum type 2 for cesarean delivery. The transversus abdominus plane(TAP) block provides sensory block from T6 to L1 for lower abdominal surgeries. Quadratous lumborum type 2 block, the injection is posterior to the quadratus lumborum muscle. This method has the advantage of a more superficial point of injection with better ultrasonographic resolution. Only one RCT was done in this context by Kalpana Verma and his colleagues comparing quadratus lumborum type 2 and posterior transversus abdominus plane block. That shows marked discrepancy with time to first analgesic request from the quadratus lumborum block in other abdominal surgeries
Interventions
PROCEDUREPosterior transversus abdominus plane block
Twenty mL of bupivacaine 0.25% will be injected in the plane between the transverses abdominus muscle and the fascia deep to the internal oblique muscle on each side
PROCEDUREQuadratus lumborum block type 2
Twenty mL of bupivacaine 0.25% will be injected on the posterior surface of quadrates lumborum muscle on each side
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)
Masking description
pain score assessment will be done by an anesthetist who is not involved in randomization or in the anesthetic technique
Intervention model description
patients will be randomly allocated via sealed opaque envelop into 2 groups of 50 patients each; Posterior transversus abdominus block (TAP) group and Quadratus lumborum block type 2 is the second group (QLB)group
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical status II parturient. * Singleton pregnancies with a gestation of at least 37 weeks. * Patients undergoing spinal anesthesia for cesarean deliveryvia a Pfannenstiel incision with exteriorization of the uterus.
Exclusion criteria
* Age \< 19 or \> 40 years. * Height\<150 cm, weight \< 60 kg, body mass index (BMI) ≥35 kg/m2. * Inability to comprehend or participatein pain scoring system. * Contraindications to spinal anesthesia (Coagulopathy, increased intracranial pressure, or local skin infection). * Hypersensitivity to any drugused in the study. * Hypertensive disorders of pregnancy. * Renal impairment or other contraindication to non-steroidal anti-inflammatory drugs. * Significant cardiovascular, renal or hepatic abnormalities. * Patients with history of opoid intake, drug abusers, psychiatric patients.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The analgesic duration | within 24 hours after the surgery | the time measured from finishing the block till the first request of analgesia by the patient |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain on movement (attempted hip flexion) or coughing | immediately and 1,2,3,4hour at postanesthesia care unit, then in the surgical ward at 6,8,10,12,18 and 24 h | 100 centimetres visual analog scale (VAS) for pain, where zero is equal to no pain and hundred indicates the worst possible pain |
| Patient satisfaction | 24 hours after surgery | poor= 1, fair = 2, good = 3, excellent = 4 |
| Heart rate | at 1st, 2nd, 3rd, 4th, 10th, 16th and 22nd hours postoperatively | beat per minute |
| Postoperative pain at rest | immediately and 1,2,3,4hour at postanesthesia care unit, then in the surgical ward at 6,8,10,12,18 and 24 h | 100 centimetres visual analog scale (VAS) for pain, where zero is equal to no pain and hundred indicates the worst possible pain |
| Total postoperative analgesic consumption of of ketolac, paracetamol and fentanyl | within the first 24 hours after surgery | Patients with visual analog scale more than 30 will receive 30 mg of intravenous ketolac in addition to 1gm paracetamol which will be repeated every 8 hours intravenous infusion of every 8 hours. Intravenous administration of fentanyl bolus doses of 0.5 µg per kg per dose will be given if the visual analog scale remains more than 30 |
| Postoperative nausea and vomiting | within 24 hours after surgery | 0= none, 1= mild, 2= moderate and 3= sever |
| Postoperative lower limb weakness | within 24 hours after surgery | reported by the patient during her first walk after surgery |
| Non-invasive blood pressure | at 1st, 2nd, 3rd, 4th, 10th, 16th and 22nd hours postoperatively | mmHg |
Countries
Egypt
Outcome results
None listed