Comparison of Quadratus Lumborum Intramuscular and Transmuscular in Postoperative Pain

Study Overview
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Brief Summary
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Acute pain is reported in approximately 80% of patients undergoing postoperative care for various types of surgical procedures in the United States. Another study reported patient postoperative pain intensity with 75% with severe pain in the first 1 to 2 postoperative days and 38% reporting moderate to severe pain at 14 postoperative days. Several modalities have been used as the standard for the management of pain postoperative C-sections. One of the postoperative analgesic modalities for SC is quadratus lumborum block (QLB). This technique has advantages in relieving postoperative pain after C-section because it is considered to be able to relieve visceral pain as well as somatic pain. The transmuscular QLB (QLBT) approach is one of the most frequently used. This technique was found to be effective with regard to the distribution of analgesics to the paravertebral spaces which is the hallmark of QLB. However, this technique was found to be difficult to perform. Difficulties were reported related to the position of the procedure i.e. lateral or sitting position.

Official Title
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Comparison of the Effectiveness of Intramuscular and Transmucular Quadratus Lumborum Blocks Quality in Postoperative Pain

Conditions
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Pain, Postoperative, Pain, Acute, Cesarean Section Complications

Intervention / Treatment
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* Other: Quadratus lumborum block after C-section surgery as postoperative pain management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Underwent C-section with subarachnoid block Aged 18-35 years old. ASA preoperative physical status 1-2 Exclusion Criteria: Coagulopathy Anatomic abnormalities of the abdomen History of allergy to local anesthesia History of hyperalgesia History of drug abuse (sedatives, opioids, paracetamol, or other pain relievers) Require postoperative intensive care Refuse to participate in research.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Quadratus lumborum intramuscular block<br>The quadratus lumborum intramuscular block will be performed immediately at the end of the surgery. Administration of 0.4 mL of 0.25% bupivacaine will be carried out under ultrasound guidance and performed by experienced anesthesiologists. | Other: Quadratus lumborum block after C-section surgery as postoperative pain management<br>* To manage postoperative pain, the subjects will be allocated to either QLB or QLTB group to receive the respective intervention.<br>|
| Active Comparator: Quadratus lumborum transmucular block<br>The quadratus lumborum transmuscular block will be performed immediately at the end of the surgery. Administration of 0.4 mL of 0.25% bupivacaine will be carried out under ultrasound guidance and performed by experienced anesthesiologists. | Other: Quadratus lumborum block after C-section surgery as postoperative pain management<br>* To manage postoperative pain, the subjects will be allocated to either QLB or QLTB group to receive the respective intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain | Postoperative pain intensity measured by Visual Analog Scale (VAS), 0=no pain, 100=worst pain | Up to 24 hours after surgery | 
| Postoperative morphine requirements | Total delivered morphine dose after surgery to alleviate postoperative pain (measured by total delivered dose recorded on the Patient-Controlled Analgesia tool) | Up to 72 hours after surgery |