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This randomized controlled trial aims to compare the effects of thoracic segmental spinal anesthesia and conventional lumbar spinal anesthesia on postoperative recovery in patients undergoing elective cesarean section. Postoperative recovery will be assessed using the ObsQoR-11 score. Hemodynamic parameters, vasopressor and anticholinergic requirements, perioperative complications, and mobilization time will also be evaluated.
Cesarean delivery is most commonly performed under lumbar spinal anesthesia; however, thoracic segmental spinal anesthesia has emerged as a potential alternative that may provide more segmental block with improved hemodynamic stability and recovery profile. This study will randomize patients to receive either lumbar spinal anesthesia at L3-4 or L4-5 levels or thoracic segmental spinal anesthesia at T10-11 or T11-12 levels. The primary outcome is postoperative recovery assessed by ObsQoR-11. Secondary outcomes include intraoperative hemodynamic changes, vasopressor (ephedrine) and atropine consumption, incidence of nausea and vomiting, post-dural puncture headache, and time to first mobilization.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lumbar Spinal Anesthesia | Active Comparator | Participants in this group will receive conventional spinal anesthesia performed at the lumbar interspace (L3-4 or L4-5). The goal is to achieve a standard sensory block level adequate for cesarean delivery. All procedures will be performed by experienced anesthesiologists under standardized conditions. Intraoperative management, including hemodynamic support and fluid administration, will follow the same institutional protocol as in the thoracic group. |
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| Thoracic Segmental Spinal Anesthesia | Experimental | Participants allocated to this group will receive spinal anesthesia performed at the thoracic interspace (T10-11 or T11-12). The technique will aim to achieve a segmental sensory block sufficient for cesarean delivery while minimizing cephalad spread. Caudal spread of the local anesthetic will be limited in order to avoid unnecessary lower extremity motor block, thereby potentially facilitating earlier postoperative mobilization. All procedures will be performed by experienced anesthesiologists under standardized monitoring conditions. Intraoperative management, including fluid therapy and vasopressor administration, will be standardized according to institutional protocols. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thoracic Segmental Spinal Anesthesia | Procedure | Thoracic Segmental Spinal Anesthesia: Spinal anesthesia will be performed at the thoracic interspace (T10-11 or T11-12) Lumbar Spinal Anesthesia: Spinal anesthesia will be performed at the lumbar interspace (L3-4 or L4-5) |
| Measure | Description | Time Frame |
|---|---|---|
| Obstetric Quality of Recovery-11 score | Quality of recovery was assessed using the Obstetric Quality of Recovery-11 (ObsQoR-11) questionnaire. Each item is scored from 0 to 10, yielding a total score ranging from 0 to 110, where 110 indicates the best possible recovery and 0 indicates the worst. | Postoperative 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Mean arterial pressure | Mean arterial pressure (MAP), defined as the time-weighted average arterial pressure over a single cardiac cycle, was calculated using the standard formula: MAP = [(2 × diastolic blood pressure) + systolic blood pressure] / 3. Continuous or intermittent MAP measurements were used to assess hemodynamic stability and adequacy of organ perfusion throughout the perioperative period. Intraoperative hypotension was predefined as a MAP <6o mmHg. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of nausea and vomiting | perioperatively and postoperative first 24 hours | |
| Rate of Post-dural puncture headache | Postoperative 48 hours |
Inclusion Criteria:
Exclusion Criteria:
Female patients scheduled for cesarean section will be enrolled in the study.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| NEZİR YILMAZ, Associate Professor | Contact | +905068939496 | yilmaznezir@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Adıyaman University Training and Research Hospital | Adıyaman | Adıyaman Province | 02200 | Turkey (Türkiye) |
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Due to the nature of the intervention, the anesthesiologist performing the block cannot be blinded. However, outcome assessment will be conducted by an investigator blinded to group allocation.
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| Lumbar Spinal Anesthesia | Procedure | Participants in this group will receive conventional spinal anesthesia performed at the lumbar interspace (L3-4 or L4-5) |
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| 0, 5, 15, 30, 45 minutes intraoperatively |
| Heart rate | Heart rate (HR), expressed as beats per minute (bpm), was continuously monitored using standard electrocardiography. HR was used as an indicator of autonomic and hemodynamic response throughout the perioperative period. Tachycardia was predefined as HR >100 bpm and bradycardia as HR <50 bpm. | 0. - 5. - 15. - 30. - 45. minutes intraoperatively |
| Time to first mobilization | Up to 24 hours postoperatively |