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All participants will receive spinal anaesthesia and will be randomly divided into 2 equal groups. In Group 1, 20 ml of local anesthetic solution will be administered bilaterally to the rectus sheath space under direct vision before closure of the anterior abdominal wall. Meanwhile, Group II will receive subdermal injections of 20 ml of local anesthetic solution before closure of the skin. Each 20 ml of local anaesthetic solution contained 0.25% Bupivacaine (50 mg/ 20 ml), 4mg dexamethazone and 1:200,000 epinephrine.
All participants will receive spinal anaesthesia and will be randomly divided into 2 equal groups. In Group 1, 20 ml of local anesthetic solution will be administered bilaterally to the rectus sheath space under direct vision before closure of the anterior abdominal wall. Meanwhile, Group II will receive subdermal injections of 20 ml of local anesthetic solution before closure of the skin. Each 20 ml of local anaesthetic solution contained 0.25% Bupivacaine (50 mg/ 20 ml), 4mg dexamethazone and 1:200,000 epinephrine.
All cases will be followed up hourly for 6 hours postoperative for assessment of level of pain by using visual analog scale (VAS). Primary outcome parameters were VAS score during rest and the need for additional analgesics during the first 48 post-operative hours. Other parameters will be time of start of lactation and ambulation, length of post-operative hospital stay, and occurrence of side effects or complications.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rectus sheath block group | Active Comparator | The participants will receive bilateral surgical rectus sheath block |
|
| Subdermal group | Active Comparator | The participants will receive subdermal infiltration of local anaesthetics. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| surgical rectus sheath block | Procedure | Local anaesthetic will be administered into the rectus sheath space by the surgeon, towards the end of the operation, at the time of closure of the anterior abdominal wall (before the closure of peritoneum) |
| Measure | Description | Time Frame |
|---|---|---|
| postoperative pain during rest | All cases will be followed up hourly for 6 hours postoperative for assessment of level of pain by using visual analog scale (VAS) | 6 hours |
| the amount of additional analgesics consumption post-operatively for pain relief. | assessment amount of intravenous analgesic consumption during hospital stay. Also, an investigator contacted them 24 hours after discharge to monitor oral analgesic analgesic | 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| time of start of lactation | the interval between skin closure and the time the patient first breastfeeds her newborn. | 24 hours |
| time of start of ambulation | the interval between skin closure and the time patient first ambulated. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Salma A. Abdelhady, Resident | Contact | 00201064328392 | salma.abdelrahman@residents.kasralainy.edu.eg | |
| Mohamed A. Hamza, Lecturer | Contact | 00201007100166 | dr.hamza.mh@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Ahmed M. Maged, Professor | Professor of Obstetrics and Gynecology at Cairo University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Obstetrics and Gynecology department of Kasr Alainy University Hospital | Cairo | El Manial | 11562 | Egypt |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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This study will be a prospective, single-blinded, randomized controlled trial (RCT) that include 182 patients scheduled for an elective lower segment Cesarean section at the Obstetrics and Gynecology department of Kasr Alainy University Hospital from April 2023 to August 2023.
After obtaining approval from the hospital's institutional review board, we assessed 182 young women scheduled for an elective lower segment Cesarean section to determine their eligibility for the study.
The182 patients admitted to be enrolled in our study, in which they're randomized into 2 groups, Group 1(n= 91) received bilateral surgical rectus sheath block and Group 2 (n =91) received subdermal infiltration of local anaesthetics.
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| subdermal local anaesthetic infiltration | Procedure | After closure of the subcutaneous fat, the edges of the skin become more stable; subdermal Infiltration with moving needle technique was done to optimize distribution of the local anesthetic solution |
|
| 24 hours |
| length of post-operative hospital stay | the interval between skin closure and the time patient discharged from hospital. | 24 hours |
| development of of side effects or complications. | The patient was observed for potential complications of RSB: The superior and inferior epigastric arteries are at risk of injury Visceral damage, Local anesthetic systemic toxicity, leading to seizures or ventricular arrhythmias (rare) Incomplete block may result from anatomical variance, as in up to 30% of the population. Failure of the block as the posterior wall of the rectus sheath lying superficial to the peritoneal cavity, needle misplacement may lead to injection into the peritoneal cavity. Infection. The patient was observed for potential complications of subdermal local anesthetic infilteration, including wound infection also the paients were observed for developemt of NSAID side effec | 24 hours |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |