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Comparison of two types of analgesia after cesarean section All patients will be anesthetized with spinal technique. Ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will be measured with visual-analog scale (VAS). 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 anesthetized patients may participate in the study. Pencil-point spinal needle and bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used.
At the end of surgery ultrasound-guided regional block will be performed. Each patient will be randomly allocated to one of the treated group: transversus abdominis plane block (TAP) or quadratus lumborum (QL). Patients receive 0.2 mL of local anesthetic solution (0.375 % ropivacaine) on each side.
Postoperative pain will be measured with VAS (visual-analog scale) 2, 4, 8, 12 and 24 hours after the end of the operation.
Paracetamol, metamizole, ketoprofen may be given as required. Whenever pain exceeds 40 (VAS) 5 mg of morphine will be given intravenously (maximum two dosages per day).
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 |
|---|---|---|---|
| TAP | Experimental | Ultrasound-guided transversus abdominis plane block at the end of cesarean section |
|
| QLB | Experimental | Ultrasound-guided quadratus lumborum block at the end of cesarean section |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TAP (transversus abdominis plane block) | Procedure | the ultrasound-guided regional block of abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375% ropivacaine administered (0.2 mL/kg). |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain | Acute pain measured with VAS (visual-analogue scale). VAS in milimmeters. Minimum value 0, maximum 100. Less better - less severe pain. 0 no pain at all. | up to 24 hours after the surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Neuropathic pain | Neuropathic pain occurrence assessed with Neuropathic Pain Symptom Inventory (NPSI) 10 descriptive variables, each one from 0 to 10. 0 means no pain. 10 very high chance of occurrence of neuropathic pain. | 6 months from the surgery |
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Inclusion Criteria:
Exclusion Criteria:
parturients
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| Name | Affiliation | Role |
|---|---|---|
| Mirosław Czuczwar, M.D., PhD | Medical University of Lublin | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| II Department of Anesthesia and Intensive Care, Medical University of Lublin | Lublin | 20-081 | Poland |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D009437 | Neuralgia |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D000077212 | Ropivacaine |
| D009339 | Needles |
| D000082 | Acetaminophen |
| D004177 | Dipyrone |
| D007660 | Ketoprofen |
| D009020 | Morphine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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Parallel Assignment
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Single (Participant)
| QL (quadratus lumborum block) | Procedure | the ultrasound-guided regional block of abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with a distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg). |
|
| Ropivacaine | Drug | In both groups (TAP&QLB) 0.375% ropivacaine will be given (0.2 mL/kg) |
|
| Needle | Device | Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study |
|
| paracetamol | Drug | Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day |
|
| metamizole | Drug | Intravenous metamizole 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 |
|
| Morphine | Drug | Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day) |
|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D000588 |
| Amines |
| D004864 | Equipment and Supplies |
| D000083 | Acetanilides |
| D000632 | Aminopyrine |
| D047069 | Pyrazolones |
| D011720 | Pyrazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D010666 | Phenylpropionates |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |