Pain, Post Operative, Cesarean Section Complications, Anesthesia, Local, Obstetric Anesthesia Problems
Conditions
Brief summary
Management of pain after caesarean section represents an important anesthesiologic issue, since it is often suboptimal, leading to delayed functional recovery and chronic pain. Currently, the postoperative analgesic strategy mostly relies on intrathecal morphine (ITM) and multimodal analgesic regimen. Recently, the need for alterative opioid sparing techniques is emerging. Paraspinal fascial plane blocks, as quadratus lumborum block (QLB) and erector spinae plane block (ESPB) performed at T9 level, have therefore been proposed as alternatives to ITM, because of their demonstrated effect on visceral and somatic pain. The aim of the study is to assess the efficacy, the feasibility and safety of bilateral ESPB compared to bilateral QLB for the management of postoperative pain after ceasarean section conducted under spinal anesthesia without ITM.
Interventions
PROCEDUREESPB
Echo-guided bilateral ESPB performed at T9 level at the end of surgery with a mixture of ropivacaine 0.375% and epinephrine 5 mcg/mL 20 mL each side.
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- Patients ASA 2 with normal singleton pregnancy, scheduled for elective caesarean section without intrathecal morphine, who underwent bilateral ESPB at the end of surgery an who gave informed consent to data collection.
Exclusion criteria
* Contraindications to spinal anesthesia; * Contraindications to or a history of opioid dependence; * Allergy to local anesthetics, acetaminophen, NSAIDs * Inability to understand pain assessment scales or to use Patient Controlled Analgesia (PCA) pump; * Patient refusal.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opioid consumption at 24 h | 24 hours from block performance | Total morphine consumption at 24 hours from block performance |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intensity of pain at 2 hours | 2 hours from block performance | NRS (Numeric Rating Scale) for pain at rest and on movement at 2 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain) |
| Intensity of pain at 6 hours | 6 hours from block performance | NRS (Numeric Rating Scale) for pain at rest and on movement at 6 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain) |
| Intensity of pain at 12 hours | 12 hours from block performance | NRS (Numeric Rating Scale) for pain at rest and on movement at 12 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain) |
| Intensity of pain at time of block performance | Time of block performance, at the end of surgery | NRS (Numeric Rating Scale) for pain at rest and on movement at time of block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain) |
| Adverse events | Any time during the first 24 hours from block performance. | Any adverse events, like sedation, itching, nausea, and other complications, particularly signs of local anesthetic toxicity, the occurrence or persistence of motor weakness at the lower extremities after spinal anesthesia recovery. |
| Time to first opioid request | Any time during the first 24 hours from block performance | Interval time between block and first opioid analgesic request |
| Differences in hemodynamic parameters | Any time during the first 24 hours from block performance | Any difference in hemodynamic parameters (non-invasive blood pressure, heart rate) |
| Intensity of pain at 24 hours | 24 hours from block performance | NRS (Numeric Rating Scale) for pain at rest and on movement at 24 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain) |
Countries
Italy
Outcome results
None listed