Regional Analgesia After Cesarean Section
Condition: Cesarean Section; Pain, Postoperative; Pain, Neuropathic
MeSH terms: Neuralgia; Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      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: 
      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.
    

Intervention name(s): TAP (transversus abdominis plane block); QLB (quadratus lumborum block); Stimuplex Ultra 360 needle; Ropivacaine; Paracetamol; subarachnoid anesthesia; PCA (patient controlled analgesia); Metamizol; Ketoprofen; Bupivacaine
Intervention type(s): Procedure; Procedure; Device; Drug; Drug; Procedure; Procedure; Drug; Drug; Drug
Intervention description(s): ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain; ultrasound-guided regional block between abdominal wall muscles to treat acute postoperative pain; ultrasound-guided needle will be used for QLB and TAP and regional blocks; 0.375 % ropivacaine will be administered for both QLB and TAP (0.2 mL per kg on both sides); Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day; subarachnoid anesthesia for each patients participating in the study with pencil point needle; 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); Intravenous metamizol 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; Subarachnoid anesthesia with spinal bupivacaine (MARCAINE SPINAL 0.5% HEAVY)
Other intervention name(s): Marcaine
Intervention MeSH terms: Acetaminophen; Dipyrone; Ketoprofen; Bupivacaine; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants were randomized 1:1:1
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: postoperative pain; transversus abdominis plane block; quadratus lumborum block; neuropathic pain