Regional Analgesia After Cesarean Section

NCT ID: NCT03244540

Last Updated: 2020-02-18

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

105 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-09-04

Study Completion Date

2019-08-30

Brief Summary

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All patients will be anaesthetized with spinal technique. Each patient will be treated with intravenous morphine - patient controlled analgesia (PCA). 2 of 3 groups of patients will receive ultrasound-guided transversus abdominis plane or quadratus lumborum block to treat postoperative pain. Postoperative pain will measured with visual-analogue scale (VAS). Total morphine consumption and time to the first demand will be noted. 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.

All patients will receive PCA (patient controlled analgesia) pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit). In PACU vital signs will be monitored.

Each patient will be randomly assigned to one of three groups. In the first group of patients no additional regional analgesia will be performed. In the second and the third group, ultrasound-guided transversus abdominis plane or quadratus lumborum block will be done with 0.375 % ropivacaine (0.2 ml per kg 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.

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, Postoperative Pain, Neuropathic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants were randomized 1:1:1
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Participants, care providers, and assessors were not aware of type of the block

Study Groups

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PCA

Subarchnoid anesthesia with bupivacaine PCA with morphine in the PACU

Group Type EXPERIMENTAL

Paracetamol

Intervention Type DRUG

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

subarachnoid anesthesia

Intervention Type PROCEDURE

subarachnoid anesthesia for each patients participating in the study with pencil point needle

PCA (patient controlled analgesia)

Intervention Type PROCEDURE

All patients will receive PCA pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit)

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

Bupivacaine

Intervention Type DRUG

Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY)

TAP

Subarchnoid anesthesia with bupivacaine 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 0.375 % ropivacaine administered (0.2 mL/kg) at the and of cesarean section.

PCA with morphine in the PACU

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

Intervention Type DEVICE

ultrasound-guided needle will be used for QLB and TAP and regional blocks

Ropivacaine

Intervention Type DRUG

0.375 % ropivacaine will be administered for both QLB and TAP (0.2 mL per kg on both sides)

Paracetamol

Intervention Type DRUG

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

subarachnoid anesthesia

Intervention Type PROCEDURE

subarachnoid anesthesia for each patients participating in the study with pencil point needle

PCA (patient controlled analgesia)

Intervention Type PROCEDURE

All patients will receive PCA pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit)

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

Bupivacaine

Intervention Type DRUG

Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY)

QLB

Subarchnoid anesthesia with bupivacaine QLB (quadratus lumborum block) ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375 % ropivacaine administered (0.2 mL/kg) at the and of cesarean section.

PCA with morphine in the PACU

Group Type EXPERIMENTAL

QLB (quadratus lumborum block)

Intervention Type PROCEDURE

ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain

Stimuplex Ultra 360 needle

Intervention Type DEVICE

ultrasound-guided needle will be used for QLB and TAP and regional blocks

Ropivacaine

Intervention Type DRUG

0.375 % ropivacaine will be administered for both QLB and TAP (0.2 mL per kg on both sides)

Paracetamol

Intervention Type DRUG

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

subarachnoid anesthesia

Intervention Type PROCEDURE

subarachnoid anesthesia for each patients participating in the study with pencil point needle

PCA (patient controlled analgesia)

Intervention Type PROCEDURE

All patients will receive PCA pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit)

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

Bupivacaine

Intervention Type DRUG

Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY)

Interventions

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TAP (transversus abdominis plane block)

ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain

Intervention Type PROCEDURE

QLB (quadratus lumborum block)

ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain

Intervention Type PROCEDURE

Stimuplex Ultra 360 needle

ultrasound-guided needle will be used for QLB and TAP and regional blocks

Intervention Type DEVICE

Ropivacaine

0.375 % ropivacaine will be administered for both QLB and TAP (0.2 mL per kg on both sides)

Intervention Type DRUG

Paracetamol

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

Intervention Type DRUG

subarachnoid anesthesia

subarachnoid anesthesia for each patients participating in the study with pencil point needle

Intervention Type PROCEDURE

PCA (patient controlled analgesia)

All patients will receive PCA pump with morphine (1 mg/mL, 5 minute interval, no loading dose) after transfer to PACU (post-anesthesia care unit)

Intervention Type PROCEDURE

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

Bupivacaine

Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY)

Intervention Type DRUG

Other Intervention Names

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Marcaine

Eligibility Criteria

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Inclusion Criteria

* obtained consent
* singleton pregnancy
* subarachnoid anaesthesia

Exclusion Criteria

* coagulopathy
* allergy to morphine and 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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Medical University of Lublin

OTHER

Sponsor Role lead

Responsible Party

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Michał Borys

associate professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Szpital Specjalistyczny PRO-FAMILIA w Rzeszowie

Rzeszów, , Poland

Site Status

Szpital Kliniczny Dzieciątka Jezus

Warsaw, , 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)

Borys M, Zamaro A, Horeczy B, Geszka E, Janiak M, Wegrzyn P, Czuczwar M, Piwowarczyk P. Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study. Int J Environ Res Public Health. 2021 Mar 28;18(7):3500. doi: 10.3390/ijerph18073500.

Reference Type DERIVED
PMID: 33800559 (View on PubMed)

Other Identifiers

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KE-0254/127/2017

Identifier Type: -

Identifier Source: org_study_id

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