Comparison of Two Pain-treatment Techniques After Cesarean Section

NCT ID: NCT02804126

Last Updated: 2023-11-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

232 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-01

Study Completion Date

2018-07-31

Brief Summary

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Comparison of two types of analgesia after cesarean section.

All patients will anaesthetised with spinal technique. Ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will measured with visual-analogue scale (VAS). 1, 2, 6 months after surgery each patient will be called to assess neuropathic pain with Neuropathic Pain Symptom Inventory (NPSI).

Detailed Description

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Written consent will be obtained before the cesarean section. Only subarachnoidally anaesthetised 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 (0.25 % bupivacaine) on each side.

Postoperative pain will be measured with VAS (visual-analogue scale) 2, 4, 8, 12 and 24 hours after the end of operation.

Paracetamol, metamizol, 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.

Conditions

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Cesarean Section Pain Management Neuropathic Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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TAP (transversus abdominis plane)

Ultrasound-guided transversus abdominis plane block at the end of cesarean section

Group Type EXPERIMENTAL

TAP (transversus abdominis plane block)

Intervention Type PROCEDURE

ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).

Bupivacaine

Intervention Type DRUG

In both groups (TAP\&QL) 0.25% bupivacaine will be given (0.2 mL/kg)

Needle

Intervention Type DEVICE

Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study

Paracetamol

Intervention Type DRUG

Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

Metamizol

Intervention Type DRUG

Intravenous metamizol will be used (1.0 gram), up to 4 grams per day

Ketoprofen

Intervention Type DRUG

Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day

Morphine

Intervention Type DRUG

Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day)

QL (quadratus lumborum)

Ultrasound-guided quadratus lumborum block at the end of cesarean section

Group Type EXPERIMENTAL

QL (quadratus lumborum block)

Intervention Type PROCEDURE

ultrasound-guided regional block between abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).

Bupivacaine

Intervention Type DRUG

In both groups (TAP\&QL) 0.25% bupivacaine will be given (0.2 mL/kg)

Needle

Intervention Type DEVICE

Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study

Paracetamol

Intervention Type DRUG

Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

Metamizol

Intervention Type DRUG

Intravenous metamizol will be used (1.0 gram), up to 4 grams per day

Ketoprofen

Intervention Type DRUG

Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day

Morphine

Intervention Type DRUG

Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day)

Interventions

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TAP (transversus abdominis plane block)

ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).

Intervention Type PROCEDURE

QL (quadratus lumborum block)

ultrasound-guided regional block between abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).

Intervention Type PROCEDURE

Bupivacaine

In both groups (TAP\&QL) 0.25% bupivacaine will be given (0.2 mL/kg)

Intervention Type DRUG

Needle

Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study

Intervention Type DEVICE

Paracetamol

Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day

Intervention Type DRUG

Metamizol

Intravenous metamizol will be used (1.0 gram), up to 4 grams per day

Intervention Type DRUG

Ketoprofen

Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day

Intervention Type DRUG

Morphine

Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day)

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* obtained consent
* singleton pregnancy
* subarachnoid anaesthesia

Exclusion Criteria

* coagulopathy
* allergy to to local anesthetics
* depression, antidepressant drugs treatment
* epilepsy
* usage of painkiller before surgery
* addiction to alcohol or recreational drugs
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Michał Borys

OTHER

Sponsor Role lead

Responsible Party

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Michał Borys

associate professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Miroslaw Czuczwar, MD, PhD

Role: STUDY_CHAIR

II Department of Anesthesiology and Intensive Care Medial University of Lublin

Locations

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II Department of Anesthesia and Intensive Care

Lublin, , Poland

Site Status

Countries

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Poland

References

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Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):550-2. doi: 10.4103/0970-9185.119148.

Reference Type BACKGROUND
PMID: 24249997 (View on PubMed)

Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol. 2015 Jan-Mar;31(1):130-1. doi: 10.4103/0970-9185.150575. No abstract available.

Reference Type BACKGROUND
PMID: 25788791 (View on PubMed)

Kanazi GE, Aouad MT, Abdallah FW, Khatib MI, Adham AM, Harfoush DW, Siddik-Sayyid SM. The analgesic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2010 Aug;111(2):475-81. doi: 10.1213/ANE.0b013e3181e30b9f. Epub 2010 May 20.

Reference Type BACKGROUND
PMID: 20488929 (View on PubMed)

Other Identifiers

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KE-0254/85/2016

Identifier Type: -

Identifier Source: org_study_id