Erector Spinae Plane Block (ESPB) Versus Quadratus Lumborum Block (QLB) for Postoperative Analgesia After Caesarean Section

Fondazione Policlinico Universitario Agostino Gemelli IRCCS52 enrolled

Overview

Management of pain after caesarean section represents an important anesthesiologic issue, since it is often suboptimal, leading to delayed functional recovery and chronic pain. Currently, the postoperative analgesic strategy mostly relies on intrathecal morphine (ITM) and multimodal analgesic regimen. Recently, the need for alterative opioid sparing techniques is emerging. Paraspinal fascial plane blocks, as quadratus lumborum block (QLB) and erector spinae plane block (ESPB) performed at T9 level, have therefore been proposed as alternatives to ITM, because of their demonstrated effect on visceral and somatic pain. The aim of the study is to assess the efficacy, the feasibility and safety of bilateral ESPB compared to bilateral QLB for the management of postoperative pain after ceasarean section conducted under spinal anesthesia without ITM.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Pain, Post Operative Cesarean Section Complications Anesthesia, Local Obstetric Anesthesia Problems

Interventions

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: \- Patients ASA 2 with normal singleton pregnancy, scheduled for elective caesarean section without intrathecal morphine, who underwent bilateral ESPB at the end of surgery an who gave informed consent to data collection. Exclusion Criteria: * Contraindications to spinal anesthesia; * Contraindications to or a history of opioid dependence; * Allergy to local anesthetics, acetaminophen, NSAIDs * Inability to understand pain assessment scales or to use Patient Controlled Analgesia (PCA) pump; * Patient refusal.

Outcomes

Primary Outcomes

Opioid consumption at 24 h

Total morphine consumption at 24 hours from block performance

Time frame: 24 hours from block performance

Secondary Outcomes

Intensity of pain at time of block performance

NRS (Numeric Rating Scale) for pain at rest and on movement at time of block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain)

Time frame: Time of block performance, at the end of surgery

Intensity of pain at 2 hours

NRS (Numeric Rating Scale) for pain at rest and on movement at 2 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain)

Time frame: 2 hours from block performance

Intensity of pain at 6 hours

NRS (Numeric Rating Scale) for pain at rest and on movement at 6 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain)

Time frame: 6 hours from block performance

Intensity of pain at 12 hours

NRS (Numeric Rating Scale) for pain at rest and on movement at 12 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain)

Time frame: 12 hours from block performance

Intensity of pain at 24 hours

NRS (Numeric Rating Scale) for pain at rest and on movement at 24 hours from block performance. NRS is an 11-point numeric scale ranging from 0 (= no pain) to 10 (=extreme pain)

Time frame: 24 hours from block performance

Adverse events

Any adverse events, like sedation, itching, nausea, and other complications, particularly signs of local anesthetic toxicity, the occurrence or persistence of motor weakness at the lower extremities after spinal anesthesia recovery.

Time frame: Any time during the first 24 hours from block performance.

Time to first opioid request

Interval time between block and first opioid analgesic request

Time frame: Any time during the first 24 hours from block performance

Differences in hemodynamic parameters

Any difference in hemodynamic parameters (non-invasive blood pressure, heart rate)