TAP vs QLB in Patients After Cesarean Delivery
Condition: Cesarean Section; Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      Comparison of two types of analgesia after cesarean section All patients will be anesthetized
      with spinal technique. Ultrasound-guided transversus abdominis plane or quadratus lumborum
      block to treat postoperative pain. Postoperative pain will be measured with visual-analog
      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: 
      Written consent will be obtained before the cesarean section. Only subarachnoidally
      anesthetized 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 (0.375 %
      ropivacaine) on each side.

      Postoperative pain will be measured with VAS (visual-analog scale) 2, 4, 8, 12 and 24 hours
      after the end of the operation.

      Paracetamol, metamizole, 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.
    

Intervention name(s): TAP (transversus abdominis plane block); QL (quadratus lumborum block); Ropivacaine; Needle; paracetamol; metamizole; Ketoprofen; Morphine
Intervention type(s): Procedure; Procedure; Drug; Device; Drug; Drug; Drug; Drug
Intervention description(s): the ultrasound-guided regional block of abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375% ropivacaine administered (0.2 mL/kg).; the ultrasound-guided regional block of abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with a distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).; In both groups (TAP&QLB) 0.375% ropivacaine will be given (0.2 mL/kg); Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study; Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day; Intravenous metamizole will be used (1.0 gram), up to 4 grams per day; Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day; Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day)
Intervention MeSH terms: Acetaminophen; Dipyrone; Ketoprofen; Morphine; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: transversus abdominis plane block; quadratus lumborum block; neuropathic pain