Quadratus Lumborum Block vs Tranversus Abdominis Plane Block for Cesarean Section
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The Quadratus Lumborum block (QLB) was first described by Blanco in 2007. The main advantage
      of QLB compared to the Transversus Abdominis Plane block (TAP) is the extension of local
      anesthetic agent beyond the TAP plane to the thoracic paravertebral space. The wider spread
      of the local anesthetic agents may produce extensive analgesia and prolonged action of the
      injected local anesthetic solution.

      Previous studies showed that both TAP block and QLB may reduce morphine requirements in the
      postoperative period in patients who had cesarean section under spinal anaesthesia. However
      there are no published reports comparing the 2 techniques.

      The aim of this randomised controlled, double blinded study is to compare the analgesic
      efficacy of QLB compared to TAP block in patients who had cesarean section under spinal
      anesthesia.
    

Detailed description: 
      After ethical committee approval, informed written consent will be obtained from all
      patients. A Sample size of 72 patients (36 per group) was calculated based on 15% reduction
      in morphine consumption with 0.05% significance and a power of 0.8.

      Consenting patients scheduled to have elective cesarean section under spinal anesthesia will
      be randomised to receive bilateral QLB or TAP at the end of surgery.The dose of local
      anaesthetic in both groups will be 0.2 ml/kg 0.125% Bupivacaine. Allocation to either group
      will be done using closed envelope technique.

      All the blocks will be performed in operation theatre after the end of cesarean section with
      intravenous access, ECG, BP, oxygen saturation by pulse oximetry monitoring and full
      resuscitation equipment and medication ready.

      All patients will be in the supine position . Under ultrasound guidance a 22 Gauge, two inch
      Pajunk Sonoplex needle will be used for both techniques. The calculated dose of local
      anaeshetic will be injected bilateraly with intermittent aspiration. The spread of injectate
      will be seed on ultrasound.

      All patients will receive the routine postoperative analgesia, comprising patient-controlled
      IV morphine analgesia and regular diclofenac and paracetamol.

      All patients will be assessed postoperatively by a blinded investigator: in the
      postanesthesia care unit and at 2, 4, 6, 12, 24, 36, and 48 h postoperatively.
    

Intervention name(s): Quadratus Lumborum block; Tranversus Abdominis plane block
Intervention type(s): Procedure; Procedure
Intervention description(s): 0.2 ml/kg bupivicaine 0.125% injected bilateraly at the posterior border of the quadratus Lumborum muscle; 0.2 ml/kg bupivicaine 0.125% injected bilateraly between internal oblique and transversus abdominis muscles.
Other intervention name(s): QLB; TAP
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment