Cesarean Section, Quadratus Lumborum Block, Transversus Abdominis Plane Block
Conditions
Brief summary
Compare the type III and type II quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) regarding efficacy in CS
Detailed description
The transversus abdominis plane block (TAPB) is administered between the internal oblique muscle and the transversus abdominis muscle in the fascial plane, directly pointing to the somatic nerves T6-L1 that run in this plane. In addition, meta-analyses demonstrate that it is an effective analgesic for somatic pain and diminishes opiate intake. It has been reported that TAPB is an efficient analgesic approach following cesarean section . The quadratus lumborum (QL) muscle block (QLB) is a fascial plane block as local anesthetic (LA) is introduced nearby to the QL muscle to numb the thoracolumbar nerves. QLB is categorized into four types according to drug administration location, I (lateral), II (posterior), III (anterior/transmuscular), and Intravenous, (intramuscular). QLB can effectively decrease both visceral and somatic pain by LA distribution to the thoracic paravertebral space (TPVS), as this block ensures effective pain control from the T7 to L1 dermatomes. QLB is one of the regional techniques that provides the greatest benefit in post-CS pain control, as it is progressively applied in obstetric anesthetic precise to improve analgesic results.
Interventions
PROCEDUREQuadratus lumborum block typen II
A 22 gauge needle was positioned between the quadratus lumborum muscle posterior border and the erector spinae muscle in the thoracolumbar fascia's middle layer
PROCEDUREQuadratus lumborum block III
A 22 gauge needle was positioned between the psoas and quadratus lumborum muscles at the anterior fascia lumbosacral
PROCEDURETransversus abdominis plane block
A 22 gauge needle was positioned between the internal oblique and transversus abdominis muscles
Sponsors
The General Authority for Teaching Hospitals and Institutes
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status II * aged 18 to 40 years old * presenting for elective Cesarean section
Exclusion criteria
* body mass index (BMI) ≥40 kg/m2 * weight \< 50kg * height \< 150 cm * contraindications for the use of active labor, spinal anesthesia * recent opiate intake * hypersensitivity to any used medication * substantial cardiovascular diseases * renal diseases * hepatic, diseases.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total postoperative consumed pethidine | 24 hour postoperatively | Numerical rating scales (NRS) score was evaluated at Post Anesthesia Care Unit (PACU), 2, 4, 6, 8, 12, 18, and 24 hours as as 0 is no pain and 10 is the worst pain imaginable. If the NRS score remained ≥ 4, we provided a bolus pethidine (0.5 mg/kg intravenous) and repeatable after 30 minutes if NRS remains≥ 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of the first analgesic request | 24 hour postoperatively | If the Numerical rating scales (NRS) score remained ≥ 4, we provided a bolus pethidine (0.5 mg/kg intravenous). |
| Patient satisfaction | 24 hour postoperatively | The level of patient satisfaction was graded on a 5-point Likert scale as 0= extremely dissatisfied, 1= dissatisfied, 2= neither satisfied nor dissatisfied, 3= satisfied, 4= extremely satisfied |
| The degree of postoperative pain | 24 hour postoperatively | Numerical rating scales (NRS ) score was evaluated at Post Anesthesia Care Unit (PACU), 2, 4, 6, 8, 12, 18, and 24 hours as as 0 is no pain and 10 is the worst pain imaginable. |
Countries
Egypt
Outcome results
None listed