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We at the Sunshine Coast University Hospital are unable to cope with the extra effort/time needed to complete this trial properly.
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| Name | Class |
|---|---|
| Sunshine Coast Hospital and Health Service | OTHER |
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The investigators are comparing post operative analgesia provided for caesarean section patients, with the quadratus lumborum type 2 block and intrathecal morphine.
In Australia the rate of birth via caesarean section (CS) has significantly increased over the last twenty years. Improvements in the care of women undergoing CS are important locally, nationally and internationally. Compared to women birthing vaginally, women undergoing CS experience more adverse events and more pain. Effective pain relief following CS is important as it enables early ambulation, encourages maternal bonding, and promotes breastfeeding initiation and establishment. Traditional analgesic techniques following CS include opioid medications. Whist effective, the use of opioids are associated with frequent and significant side effects. Alternative analgesic agents are being explored in an attempt to improve the effectiveness of pain relief available to women and clinicians.
The quadratus lumborum block (QLB) block is an innovative regional analgesic technique. Its role as an effective analgesic agent in abdominal surgery is increasing. However, it has not been studied for pain relief in Australia after cesarean section.
In this study, the investigator aims to compare post-operative analgesia and side effects between the QLB blocks versus adding morphine the participant's spinal anaesthetic (ITM) during the elective C/S. Results from this study will provide information on the analgesic impact of this new and emerging therapy and assist in the development of a larger clinical trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Saline intrathecal as well as saline in Blocks | Sham Comparator | These 25 patients will receive 0.3ml saline added to the spinal anaesthetic and 25 ml saline both sides as a QLB2. |
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| Saline intrathecal as well as local anaesthetic in Blocks | Active Comparator | These 25 patients will receive 0.3ml saline added to the spinal anaesthetic and 25 ml local anaesthetic both sides as a QLB2. |
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| Intrathecal morphine as well as local anaesthetic in Blocks | Active Comparator | These 25 patients will receive 0.3ml (150mcg) morphine added to the spinal anaesthetic and 25 ml local anaesthetic both sides as a QLB2. |
|
| Intrathecal morphine as well as saline in Block | Active Comparator | These 25 patients will receive 0.3ml (150mcg) morphine added to the spinal anaesthetic and 25 ml saline both sides as a QLB2. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intrathecal morphine as well as local anaesthetic in Blocks | Procedure | A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle. 150mcg morphine will be added to the spinal anaesthetic. |
| Measure | Description | Time Frame |
|---|---|---|
| 24 hours total intravenous morphine usage via a PCA pump | Post operative intravenous morphine use will be noted at 24 hours post cesarean section | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Patient's side effects within the 24 hours post operative period. | Nausea, vomiting, itching, herpes reactivation, urinary retention and sedation will be noted. | 24 hours |
| Pain Scores within 24 hours post operative period. |
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Inclusion Criteria:
Exclusion Criteria:
Female patients undergoing elective cesarean sections
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| Name | Affiliation | Role |
|---|---|---|
| Willem Basson, FANZCA | Sunshine Coast University Hospital | Principal Investigator |
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4 groups of 25 patients each. All patients will receive a spinal and a quadratus lumborum type 2 block. The groups will have a combination of ITM / QLB or both or neither.
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Double blinded
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| Intrathecal morphine as well as saline in Block | Procedure | 150mcg morphine will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block. |
|
| Saline intrathecal as well as saline in Blocks | Procedure | 0.3 ml saline will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block. |
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| Saline intrathecal as well as local anaesthetic in Blocks | Procedure | 0.3 ml saline will be added to the spinal anaesthetic. A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle. |
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Using a VAS we will note both dynamic and static pain scores at 24 hours post operative
| 24 hours |
| ID | Term |
|---|---|
| D059787 | Acute Pain |
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000772 | Anesthesia, Local |
| D003766 | Dental Occlusion |
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D003813 | Dentistry |
| D009063 | Dental Physiological Phenomena |
| D055688 | Digestive System and Oral Physiological Phenomena |
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017670 | Sodium Compounds |
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