This patient population are at risk of adverse effects secondary to inadequate pain management such as inadequate maternal bonding and late ambulation. Regional analgesia is preferred due to their opioid sparing effects and reduction in related adverse effects but the analgesia from these blocks is not known which one is superior to the other in the context of cesarean section
The aim of this study is to compare the effect of posterior transversus abdominus plane block and quadratus lumborum type 2 for cesarean delivery. The transversus abdominus plane(TAP) block provides sensory block from T6 to L1 for lower abdominal surgeries. Quadratous lumborum type 2 block, the injection is posterior to the quadratus lumborum muscle. This method has the advantage of a more superficial point of injection with better ultrasonographic resolution. Only one RCT was done in this context by Kalpana Verma and his colleagues comparing quadratus lumborum type 2 and posterior transversus abdominus plane block. That shows marked discrepancy with time to first analgesic request from the quadratus lumborum block in other abdominal surgeries
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
100
Twenty mL of bupivacaine 0.25% will be injected in the plane between the transverses abdominus muscle and the fascia deep to the internal oblique muscle on each side
Twenty mL of bupivacaine 0.25% will be injected on the posterior surface of quadrates lumborum muscle on each side
El Mansoura
El Mansoura, Egypt
The analgesic duration
the time measured from finishing the block till the first request of analgesia by the patient
Time frame: within 24 hours after the surgery
Postoperative pain at rest
100 centimetres visual analog scale (VAS) for pain, where zero is equal to no pain and hundred indicates the worst possible pain
Time frame: immediately and 1,2,3,4hour at postanesthesia care unit, then in the surgical ward at 6,8,10,12,18 and 24 h
Postoperative pain on movement (attempted hip flexion) or coughing
100 centimetres visual analog scale (VAS) for pain, where zero is equal to no pain and hundred indicates the worst possible pain
Time frame: immediately and 1,2,3,4hour at postanesthesia care unit, then in the surgical ward at 6,8,10,12,18 and 24 h
Patient satisfaction
poor= 1, fair = 2, good = 3, excellent = 4
Time frame: 24 hours after surgery
Heart rate
beat per minute
Time frame: at 1st, 2nd, 3rd, 4th, 10th, 16th and 22nd hours postoperatively
Non-invasive blood pressure
mmHg
Time frame: at 1st, 2nd, 3rd, 4th, 10th, 16th and 22nd hours postoperatively
Total postoperative analgesic consumption of of ketolac, paracetamol and fentanyl
Patients with visual analog scale more than 30 will receive 30 mg of intravenous ketolac in addition to 1gm paracetamol which will be repeated every 8 hours intravenous infusion of every 8 hours. Intravenous administration of fentanyl bolus doses of 0.5 µg per kg per dose will be given if the visual analog scale remains more than 30
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Time frame: within the first 24 hours after surgery
Postoperative nausea and vomiting
0= none, 1= mild, 2= moderate and 3= sever
Time frame: within 24 hours after surgery
Postoperative lower limb weakness
reported by the patient during her first walk after surgery
Time frame: within 24 hours after surgery