Comparison of Two Pain-treatment Techniques After Cesarean Section
Condition: Cesarean Section; Pain Management; Neuropathic Pain
MeSH terms: Neuralgia
Study type: Interventional
Phase: Phase 4

Summary: 
      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: 
      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.
    

Intervention name(s): TAP (transversus abdominis plane block); QL (quadratus lumborum block); Bupivacaine; Needle; Paracetamol; Metamizol; Ketoprofen; Morphine
Intervention type(s): Procedure; Procedure; Drug; Device; Drug; Drug; Drug; Drug
Intervention description(s): 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).; 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).; In both groups (TAP&QL) 0.25% bupivacaine 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 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; 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; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: acute pain; transversus abdominis plane block; quadratus lumborum block; neuropathic pain