A Comparative Study Between Quadratus Lumborum Block Type 2 and Posterior Transversus Abdominus Plane Block for Analgesia After Cesarean Delivery Under Spinal Anesthesia
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- The analgesic duration
研究概览
简要总结
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
详细描述
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
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Double (Participant, Investigator)
盲法说明
pain score assessment will be done by an anesthetist who is not involved in randomization or in the anesthetic technique
入排标准
- 年龄范围
- 20 Years 至 40 Years（Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •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.
排除标准
- •Age < 19 or > 40 years.
- •Height<150 cm, weight < 60 kg, body mass index (BMI) ≥35 kg/m
- •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.
研究组 & 干预措施
Posterior transversus abdominus block
After the surgery end and while the patient in the supine position, with the side to be blocked is elevated
A 12-14 MHz linear array transducer will be placed transversely between the iliac crest and costal margin then slided from medial-lateral to visualize the posterior most part of the external oblique, internal oblique, and transversus abdominus muscles
Then 20 mL of bupivacaine0.25% will be injected between the transverses abdominus muscle and the fascia deep to the internal oblique muscle
The same steps will be repeated on the other side
干预措施: Posterior transversus abdominus plane block (Procedure)
Quadratus lumborum block type 2
After the surgery end and while the patient in the supine position, with the side to be blocked is elevated
A2-5 MHz curved array transducer will be placed at the level of the antero-superior iliac spine then the external oblique muscle will be followed posterolaterally until its posterior border will be visualized The probe will be tilted down to identify a bright hyperechoic line After that 20 mL of bupivacaine 0.25% will be injected under direct visualization on the posterior surface of quadrates lumborum muscle
The same steps will be repeated on the other side
干预措施: Quadratus lumborum block type 2 (Procedure)
结局指标
主要结局
The analgesic duration
时间窗: within 24 hours after the surgery
the time measured from finishing the block till the first request of analgesia by the patient
次要结局
- 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)
- Postoperative nausea and vomiting(within 24 hours after surgery)
- Patient satisfaction(24 hours after surgery)
- Heart rate(at 1st, 2nd, 3rd, 4th, 10th, 16th and 22nd hours postoperatively)
- Non-invasive blood pressure(at 1st, 2nd, 3rd, 4th, 10th, 16th and 22nd hours postoperatively)
- 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)
- Postoperative lower limb weakness(within 24 hours after surgery)
- Total postoperative analgesic consumption of of ketolac, paracetamol and fentanyl(within the first 24 hours after surgery)
研究者
maha abou-zeid
Assistant professor of anesthesia and surgical intensive care
Mansoura University