A clinical study between transverse abdominis plane block and quadratus lumborum block for pain management in Caesarean Section operation.

Not yet recruiting

• Conditions: Encounter for cesarean delivery without indication,

• Registration Number: CTRI/2022/08/044599
• Lead Sponsor: Dr Ananya Devi

Brief Summary

Effectivepost-operative analgesia after caesarean section (CS) is important because itfacilitates early amelioration, ambulation and expedites breastfeeding. Itprevents various undesirable side effects such as respiratory complications,venous thromboembolism, and increased hospital stay. Commonly, opioids are usedfor post-caesarean pain relief which is associated with respiratory depression,gastrointestinal side effects, pruritus, itching, urinary retention etc.Multimodal analgesia techniques have been applied in post operative painmanagement,  such as NSAIDs ,opioids, regional anaesthesia etc .Amongstthese ,regional anaesthesia is widely practised nowadays and gainingpopularity. Regional anaesthesia can be done by both landmark guided and Ultrasoundguided method .Various truncal blocks are used for analgesia for caesareansection such as transversus abdominis plane block, rectus sheath block, erectorspinae block ,quadratus lumborum block etc.

The transversusabdominis plane(TAP) block involves injecting local anaesthetic into the planebetween Transversus abdominis and Internal oblique, which block the sensorynerve supply to the anterior abdominal wall. TAP block is an easy and mostcommonly done procedure for post-operative analgesia, as already beenestablished in many studies.

The Quadratuslumborum (QL) block is a posterior abdominal wall block which permits spread oflocal anaesthetic agent around the quadratus lumborum muscle into a triangularspace known as a lumbar interfascial triangle which lies beside the middlelayer of the thoracolumbar fascia. There are not many studies that have beendone regarding QL block. So in our study we will compare quadratus lumborumblock with transversus abdominis block.

References:

1.   1. Kerai S, Saxena KN, Taneja B. Post-caesareananalgesia: What is new? *Indian J Anaesth.*2017;61:200–14.

2.   2. Sinha A, Jayaraman L, Punhani D, Chowbey P.Transversus abdominis plane block for pain relief in patients undergoing inendoscopic repair of abdominal wall hernia: A comparative, randomiseddouble-blind prospective study. *J Minim Access Surg*.2018;14(3):197-201.

3.   3. Ghisi D, Fanelli A, Vianello F, Gardini M, Mensi G,La Colla L, Danelli G. Transversus Abdominis Plane Block for PostoperativeAnalgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized,Controlled, Observer-Blinded Trial. Anesth Analg. 2016 Aug;123(2):488-92.

4.   4. Schuenke MD, Vleeming A, Van Hoof T, Willard FH. Adescription of the lumbar interfascial triangle and its relation with thelateral raphe: Anatomical constituents of load transfer through the lateralmargin of the thoracolumbar fascia. *J Anat.*2012;221:568–76.

5.   5. Verma, Kalpana et al. “Comparison of transversusabdominis plane block and quadratus lumborum block for post-caesarean sectionanalgesia: A randomised clinical trial.†*Indian  Journal ofAnaesthesia* vol. 2019: 63(10): 820-826.

6.   6. Yousef NK. Quadratus Lumborum Block versusTransversus Abdominis Plane Block in Patients Undergoing Total AbdominalHysterectomy: A Randomized Prospective Controlled Trial. Anesth Essays Res.2018 Jul-Sep;12(3):742-747.

Detailed Description

Not available

Study Timeline

• Last Update Posted: 2022-07-27
• Study Start: 2022-10-08

Recruitment & Eligibility

• Status: Not Yet Recruiting
• Sex: Female
• Target Recruitment: 72

Inclusion Criteria

• ASA physical status 2 2.
• Normal singleton pregnancy with a gestational period of minimum 37 weeks 3.
• Elective caesarean section under spinal anaesthesia 4.
• Informed and written consent.

Exclusion Criteria

1.Patient not willing to give consent 2.Patient belonging to ASA physical status 3 or more 3.Allergy to study drugs 4.Infection at the site of block 5.Patient with known coagulopathy or patients on anticoagulation therapy 6.Patient with pregnancy induced hypertension 7.Patient with gestational diabetes mellitus 8.Patient with fetal distress 9.Patient with cardiac disease 10.Patient with kidney disease 11.Patient with morbid obesity.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To compare the duration of analgesia in each group after administration of block in the post operative period	Analgesia will be assessed at 2,4,6,12,24 post operative hours

Secondary Outcome Measures

Name	Time	Method
1. To compare the total number of analgesic dose required over a period of 24 hours.	2. To compare the severity of post operative pain assessment via numerical rating scale.

Trial Locations

Locations (1)

Gauhati Medical College and Hospital; 🇮🇳 Kamrup, ASSAM, India

Gauhati Medical College and Hospital

🇮🇳Kamrup, ASSAM, India

Dr Ananya Devi

Principal investigator

9706551974

ananyadevi1994@gmail.com