Postoperative pain control after cesarean sections
Conditions
Interventions
For the intrathecal morphine group,
they will prepare a syringe of 0.75% hyperbaric bupivacaine (due to the lack of availability of 0.75% hyperbaric bupivacaine in Thailand,
0.5% hyperbaric bupivacaine with the same dose of 10-
12 mg is used instead),
10ucg of fentanyl and 100ucg of spinal study medication. The spinal study medication will be 200 microlitres of normal saline in the ESP group,
and 200microlitres of spinal morphine (100ucg) in the morphine group. The patient will then be placed supine with a wedge under the right hip. The block height will be confirmed with ice 4 minutes af
the management will be left to the treating anesthesiologist. We will record the amount of fentanyl used,
and will be able to see if there is a difference between groups.
For TU center,
due to the lack of availability of 0.75% hyperbaric bupivacaine in Thailand,
12 mg is used instead. To limit the volume of the spinal injection. We will use 1.9-
2 ml of 0.5%bupivacaine + 0.1 mg of morphine will be diluted 0.5% bupivacaine (volume 0.1ml) + 0.2 ml of 10 mcg fentanyl,
the total injectate volume will not exceed 2.3 ml.
,At the end of the surgery the patient will be turned into the lateral position. The erector spinae blocks will be performed as follows:
1.Placemen
Active Comparator Procedure/Surgery,Active Comparator Procedure/Surgery
Intrathecal morphine,Erector Spinae Plane block
Sponsors
Thammasat University Hospital
Eligibility
Sex/Gender
Female
Age
18 Years to 45 Years
Inclusion criteria
Inclusion criteria: â–ª Only women able to provide informed consent will be recruited for study participation â–ª Patients between 18 and 45 years â–ª Patients undergoing elective lower segment (transverse incision) cesarean sections under spinal anesthesia
Exclusion criteria
Exclusion criteria: â–ª ASA patients greater than or equal to 3. â–ª Allergies to local anesthetics â–ª Contraindication of neuraxial analgesia. â–ª Patients with hemodynamic instability â–ª Patients with systemic diseases: Coagulopathies, chronic use of analgesics, hypertensive disorders. â–ª Patients with chronic pain â–ª Patients with inability to comprehend or use the Numeric Rating Scale pain scoring system and difficulty to evaluate pain â–ª Patients unable to communicate in English or French (in Thai for Thammasat University center) â–ª Illness associated with pregnancy or high obstetric risk (gestational diabetes, pre-eclampsia, oligo and polyhydramnios, multiple pregnancy, anatomic malformations, etc.)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Dynamic pain 3 6 12 18 and 24 hours after the end of the cesarean delivery Visual Analog Scale | — |
Secondary
| Measure | Time frame |
|---|---|
| Pain at rest 3 6 12 18 and 24 hours after the end of the cesarean delivery Visual Analog Scale,Quality of recovery after cesarean delivery 24 hours after the end of the cesarean delivery ObsQoR11 Questionaire,Chronic pain 3 months after the cesarean a modification of the brief pain inventory | — |
Countries
Thailand
Contacts
Public ContactArraya Watanitanon
Thammasat University
Outcome results
None listed