Anesthesia, Postoperative Pain
Conditions
Keywords
Cesarean section, intrathecal morphine, posterior quadratus lumborum block
Brief summary
In this study, it was aimed to evaluate the effects of intrathecal morphine and posterior quadratus lumborum block (QLB2) on postoperative acute pain scores and opioid consumption in the first 24 hours after cesarean section.
Detailed description
Postoperative acute pain following a cesarean section is sharp, well-localized, and highly intense. An ideal pain management approach after a cesarean section should provide high-quality analgesia with minimal side effects and facilitate the mother's rapid return to daily activities. Different options for pain control include central blocks, peripheral blocks, and systemic medications. Intrathecal morphine (ITM) administration is a widely used approach for post-cesarean pain management both globally and in our clinic. However, it can reduce patient satisfaction due to side effects such as nausea, vomiting, and itching. On the other hand, the Quadratus Lumborum Block (QLB), a type of peripheral block, has proven analgesic efficacy in controlling acute postoperative pain following a cesarean section. The aim of this study is to examine and compare the analgesic efficacy of intrathecal morphine (ITM) and Posterior Quadratus Lumborum in the management of acute postoperative pain after a cesarean section. This study is a single-center, double-blind, prospective observational study. Patients will be divided into 2 groups. Group 1: The group receiving intrathecal morphine (ITM) Group 2: The group receiving Posterior Quadratus Lumborum Block In elective cesarean section cases under spinal anesthesia, the patient group receiving ITM and posterior QLB will be evaluated for obstetric general well-being during the first 24 hours and at discharge. Total morphine consumption in the first 24 hours, Pain scores (NRS) at rest and during movement, presence of nausea-vomiting and itching, patient satisfaction and any potential side effects will be recorded through follow-up.
Interventions
PROCEDUREIntrathecal Morphine (ITM)
morphine 100 mcg + 12.5 mg bupivacaine + 20 mcg fentanyl
PROCEDUREQuadratus Lumborum II (QLB-II) Block
12.5 mg bupivacaine + 20 mcg fentanyl bilateral QLB block (posterior tip 2) 25 cc 0.25% bupivacaine
Sponsors
Ondokuz Mayıs University
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Pregnant for at least 37 weeks * Aged between 18 and 45 * ASA (American Society of Anesthesiologists) physical status score II * Patient planned for elective cesarean section under spinal anesthesia * Patient receiving QLB-II block or intrathecal morphine
Exclusion criteria
* ASA score of III or IV. * Planned cesarean section under general anesthesia. * Requirement for conversion to general anesthesia after failed spinal anesthesia. * Contraindication to spinal anesthesia and regional anesthesia techniques. * BMI greater than 35 kg/m². * History of opioid use disorder or opioid use for more than 4 weeks. * Inability to assess pain scores. * Pregnancies of less than 37 weeks gestation. * History of allergy to local anesthetics and systemic opioids. * Patient refusal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption in the first 24 hours after surgery | Postoperative day 1 | Morphine consumption in the first 24 hours will be measured by IV PCA. Patients will be able to request opioids via a PCA device when their NRS score is above 4 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain scores | Postoperative day 1 | Pain status at rest and while coughing will be assessed by NRS scores at 0, 3, 6, 12, and 24 hours after operation.The NRS is an 11-point numeric scale which ranges from 0 to 10. |
| Postoperative nausea and vomiting (PONV) scores | Postoperative Day 1 | The severity of postoperative nausea and vomiting (PONV) will be assessed using a descriptive verbal rating scale at 0, 3, 6, 12, 18, and 24 hours after extubation. If a score of 3 or more, ondansetron 4 mg IV will be administered and will repeat after 8 hours if required. The PONV scale is 0 = no nausea; 1 = slight nausea; 2 = moderate nausea; 3 = vomiting once; and 4 = vomiting more than once. |
| The number of patient required rescue analgesic | Postoperative Day 1 | The number of patient requires rescue analgesic will be recorded at 0, 3, 6, 18, and 24 hours after operation |
| Postoperative pruritus score | Postoperative Day 1 | Pruritus score: 0 = no pruritus; 1 = sensation of itching, but not scratching, just a rubbing sensation (mild); 2 = sensation of itching and scratching (moderate); 3 = sensation of pruritus, scratching, and requiring treatment (severe). |
| Patients' satisfaction and quality of pain management | Postoperative Day 1 | Patients' pain management satisfaction and quality will be evaluated using the QoR-11 score. ObsQoR-11 is an 11-item questionnaire that is used to evaluate the recovery of parturient women after elective CS. ObsQoR-11 is evaluated in terms of the degree of post-operative pain, nausea, vomiting, activity, baby care, hygiene,and emotional control. Each item was scored using an 11-point system, with minimum and maximum scores of 0 and 110, respectively. A high score reflects good recovery. QoR-11 Turkish Version will be used for assessment. |
Countries
Turkey (Türkiye)
Outcome results
None listed