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All patients will be anaesthetized with spinal technique. Each patient will be treated with intravenous morphine - patient controlled analgesia (PCA). 2 of 3 groups of patients will receive ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will measured with visual-analogue scale (VAS). Total morphine consumption and time to the first demand will be noted. 1, 2, 6 months after surgery each patient will be called to assess neuropathic pain with Neuropathic Pain Symptom Inventory (NPSI).
Written consent will be obtained before the cesarean section. Only subarachnoidally anaesthetised patients may participate in the study. Pencil-point spinal needle and bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used.
All patients will receive PCA (patient controlled analgesia) pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit). In PACU vital signs will be monitored.
Each patient will be randomly assigned to one of three groups. In the first group of patients no additional regional analgesia will be performed. In the second and the third group, ultrasound-guided transversus abdominis plane or quadratus lumborum block will be done with 0.375 % ropivacaine (0.2 ml per kg on each side).
Postoperative pain will be measured with VAS (visual-analogue scale) 2, 4, 8, 12 and 24 hours after the end of operation.
Paracetamol, metamizol, ketoprofen may be given as required.
1, 3, 6 months patients will be called to assess neuropathic pain. Neuropathic Pain Symptom Inventory (NPSI) will be used.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PCA | Experimental | Subarchnoid anesthesia with bupivacaine PCA with morphine in the PACU |
|
| TAP | Experimental | Subarchnoid anesthesia with bupivacaine TAP (transversus abdominis plane block) ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375 % ropivacaine administered (0.2 mL/kg) at the and of cesarean section. PCA with morphine in the PACU |
|
| QLB | Experimental | Subarchnoid anesthesia with bupivacaine QLB (quadratus lumborum block) ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375 % ropivacaine administered (0.2 mL/kg) at the and of cesarean section. PCA with morphine in the PACU |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TAP (transversus abdominis plane block) | Procedure | ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain |
|
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain measured with VAS | Acute pain measured with VAS (visual-analogue scale) | up to 24 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Neuropathic pain assessed with NPSI | Neuropathic pain occurrence with Neuropathic Pain Symptom Inventory (NPSI) | 6 months from the surgery |
| Morphine consumption | Total morphine consumption |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Szpital Specjalistyczny PRO-FAMILIA w Rzeszowie | Rzeszów | 35-001 | Poland | |||
| Szpital Kliniczny DzieciÄ…tka Jezus |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24249997 | Background | Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):550-2. doi: 10.4103/0970-9185.119148. | |
| 25788791 | Background | Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol. 2015 Jan-Mar;31(1):130-1. doi: 10.4103/0970-9185.150575. No abstract available. |
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Participants were randomized 1:1:1
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Participants, care providers, and assessors were not aware of type of the block
| QLB (quadratus lumborum block) | Procedure | ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain |
|
| Stimuplex Ultra 360 needle | Device | ultrasound-guided needle will be used for QLB and TAP and regional blocks |
|
| Ropivacaine | Drug | 0.375 % ropivacaine will be administered for both QLB and TAP (0.2 mL per kg on both sides) |
|
| Paracetamol | Drug | Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day |
|
| subarachnoid anesthesia | Procedure | subarachnoid anesthesia for each patients participating in the study with pencil point needle |
|
| PCA (patient controlled analgesia) | Procedure | All patients will receive PCA pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit) |
|
| Metamizol | Drug | Intravenous metamizol will be used (1.0 gram), up to 4 grams per day |
|
| Ketoprofen | Drug | Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day |
|
| Bupivacaine | Drug | Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY) |
|
|
| up to 24 hours after surgery |
| Warsaw |
| 02-005 |
| Poland |
| 33800559 | Derived | Borys M, Zamaro A, Horeczy B, Geszka E, Janiak M, Wegrzyn P, Czuczwar M, Piwowarczyk P. Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study. Int J Environ Res Public Health. 2021 Mar 28;18(7):3500. doi: 10.3390/ijerph18073500. |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D009437 | Neuralgia |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D000077212 | Ropivacaine |
| D000082 | Acetaminophen |
| D016058 | Analgesia, Patient-Controlled |
| D004177 | Dipyrone |
| D007660 | Ketoprofen |
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D000083 | Acetanilides |
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
| D000632 | Aminopyrine |
| D047069 | Pyrazolones |
| D011720 | Pyrazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D010666 | Phenylpropionates |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
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