Quadratus Lumborum Block After Cesarean Section: Analgesic Efficacy of Different Concentrations of Local Anesthetics

NCT ID: NCT05643846

Last Updated: 2024-12-31

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

196 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-02-27

Study Completion Date

2025-12-06

Brief Summary

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QLB is an injection of a local anesthetics around the quadratus lumborum muscle. It uses a fascial compartment path to extend the distribution of local anesthetics into the posterior abdominal wall and paravertebral space. This central effect can be of vital importance when managing the visceral pain after caesarean section.

Many studies have shown that the inclusion of quadratus lumborum block to a multimodal analgesic regimen would reduce pain scores, opioid consumption, and prolonging time to first rescue analgesic after cesarean delivery.

However, the dose and concentration of the local anesthetic used among the studies are varied, and literature search identified no randomized controlled trial which looked at the concentration -response of local anesthetic to optimize the concentration resulting in the best pain relief.

It is a perspective randomized controlled trial to compare the analgesic efficacy of 2 different concentrations of Bupivacaine to standardize postoperative analgesic protocol used for QLB after caesarean section.

Detailed Description

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QLB is an injection of a local anesthetics around the quadratus lumborum muscle. It uses a fascial compartment path to extend the distribution of local anesthetics into the posterior abdominal wall and paravertebral space. Acute post C-section pain is a leading anesthetic concern for women; a key determinant of maternal satisfaction; may lead to persistent postoperative pain; is a predictor of postpartum depression; and can reduce early breastfeeding success. Effective postoperative analgesia should, therefore, be prioritized to improve outcomes following caesarean delivery. This study is a Double-blinded, randomized and controlled trial.

A written, informed consent is discussed with and signed by all participants, and the participants are randomly assigned into one of two groups; (Group 1) to receive bilateral QLB with '0.125% bupivacaine 0.2 ml/ kg', (Group 2) to receive bilateral QLB with '0.25% bupivacaine 0.2 ml/kg'. For all participants, spinal anesthesia is performed with ultrasonography guidance in a standardized manner using hyperbaric bupivacaine 15mg and fentanyl 25 μg.

At the end of the procedure in the supine position, all participants receive bilateral QLBs performs under ultrasound guidance and aseptic technique. The internal oblique muscle is identified and followed laterally to the lateral interfacial triangle sitting above the quadratus lumborum muscle.

Results will be reported as

1. Total number of PCA morphine demands and the actual doses delivered at predetermined time intervals (1h, 2 h, 4h, 6 h, 12 h, 24 h and 48 h) after surgery
2. Record of supplemental and regular analgesics.
3. Visual analogue score for pain at rest (static) and with movement (dynamic) (defined as the elevation of the head and shoulders off the pillow from the supine position), (0, no pain; 10, worst pain imaginable).
4. Residual nerve block (the time to mobilization)
5. Block-related complications (i.e., hematoma, organ injury, local anesthetic systemic toxicity, and sepsis).

6- Opioids-related side effects (Nausea, Vomiting, Itching)

The investigators hypothesized that using a higher concentration (0.25%) of local anesthetic (Bupivacaine) would increase the analgesic effect without increasing the side effects and complications.

Conditions

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Outcome Measures

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

It is a Prospective, Double-blinded, randomized and controlled clinical trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Participants are allocated randomly by means of computer generation sequencing. The allocation sequence with unique study number for each participant will be concealed in sequentially numbered, opaque, sealed, and stapled envelopes. This envelope will be opened by an anesthetist who was not involved in the study. This Anesthetist prepares the study medication as per the allocation and labels the syringe with the unique study number; this number will be used to identify the study medication and will be revealed only on completion of data collection at the end of the study. The investigators, participants and other healthcare providers who are involved in postoperative care, are blinded to the participant's group allocation.

Study Groups

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(Group 1) will receive the intervention 'Bupivacaine at concentration of 0.125%, dose of 0.2 ml/kg'.

(Group 1) will receive bilateral QLB procedure with the intervention 'Bupivacaine local anesthetic drug at concentration of 0.125% concentration, at a dose of 0.2 ml/kg'.

Group Type ACTIVE_COMPARATOR

QLB procedure after cesarean section

Intervention Type PROCEDURE

Bupivacaine local anesthetic drug used for QLB procedure after Cesarean section. Intervention of two different concentration of Bupivacaine, 0.125% or 0.25%, at a dose of 0.2 ml/kg.

(Group 2) will receive the intervention 'Bupivacaine concentration of 0.25%, dose of 0.2 ml/kg'.

(Group 2) will receive bilateral QLB procedure with the intervention 'Bupivacaine local anesthetic drug at a concentration of 0.25% concentration, at a dose of 0.2 ml/kg'.

Group Type ACTIVE_COMPARATOR

QLB procedure after cesarean section

Intervention Type PROCEDURE

Bupivacaine local anesthetic drug used for QLB procedure after Cesarean section. Intervention of two different concentration of Bupivacaine, 0.125% or 0.25%, at a dose of 0.2 ml/kg.

Interventions

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QLB procedure after cesarean section

Bupivacaine local anesthetic drug used for QLB procedure after Cesarean section. Intervention of two different concentration of Bupivacaine, 0.125% or 0.25%, at a dose of 0.2 ml/kg.

Intervention Type PROCEDURE

Other Intervention Names

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Bupivacaine Local anesthetic drug at concentrations of 0.125% or 0.25% Marcaine local anesthetic drug at concentration of 0.125% or 0.25%, at a dose of 0.2ml/kg

Eligibility Criteria

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Inclusion Criteria

* Participants who are American Society of Anesthesiologists physical status 1 or 2.
* Participants who have singleton pregnancy at a gestation of at least 37 weeks.
* Participant who are scheduled for elective caesarean section under spinal anesthesia.
* Participants who are consented to be enrolled into the study.

Exclusion Criteria

* Patients who have contraindications to spinal or regional anesthesia (Coagulopathy or on anticoagulants).
* Who have Allergy or sensitivity to study medications.
* Who have anatomical abnormalities or localized infection.
* Who have history of chronic pain or on regular opioids use.
* Who are unable to comprehend or unable to use the verbal rating pain scoring system,
* Failed spinal anesthesia or conversion to general anesthesia after spinal anesthesia.
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Danat Al Emarat Hospital

OTHER

Sponsor Role lead

Responsible Party

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JINAN AHMED JAMEEL AL ALOOSI

Principle Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Danat Al Emarat hospital

Abu Dhabi, , United Arab Emirates

Site Status

Countries

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United Arab Emirates

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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RP DAE/2022/102

Identifier Type: -

Identifier Source: org_study_id