Ultrasound Guided QLB III Versus Intrathecal Morphine for Analgesia After Cesarean Section

Study Overview
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Brief Summary
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Subarachnoid morphine (SAM) is the gold standard for treating postoperative pain after cesarean delivery (CD) but it has undesirable side effects, that's why the aim of our study is to identify whether ultrasound-guided Quadratus lumborum block type 3, a new regional anesthetic technique that blocks the abdominal wall neural afferents, can provide at the same time better postoperative analgesia after CD with less side effects

Detailed Description
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In this prospective double blinded randomized study,120 parturients undergoing cesarian delivery via a Pfannenstiel incision and who agreed to spinal anesthesia were randomly scheduled to receive either a SAM (group SAM, n=60) or a Quadratus lumborum block type 3 (group QLB, n=60).Spinal anesthesia was initiated with hyperbaric Bupivacaïne 0.5% 10 mg, 0,005 mg SUFENTANIL MEDIS and 0.1 mg morphine in the SAM group and with Bupivacaïne 0.5% 10 mg, 0,005 mg SUFENTANIL MEDIS and 1 ml normal saline in group QLB. After surgery, bilateral QLB block type 3 was performed with the patient in lateral position using bupivacaine 0.25% , 20 mL on each side in group QLB and 20 ml normal saline in group SAM. Postoperative analgesia for the first 24 hours consisted of a patient controlled analgesia with IV morphine only. If necessary breakthrough pain was treated by 01 g paracetamol intravenously by the same doctor in charge of taking the values of the visual analogue scale. Patients were assessed postoperatively in the postanesthesia care unit (time 0 hours) and at 2, 4, 6, 12 and 24 hours. Visual analogue scale (VAS) for pain at rest and during the palpation of the uterine globe was noted. The primary outcome measure was the total dose of morphine over 24 hours delivered by a patient-controlled analgesia system at predetermined intervals. Secondary outcomes were visual analogue scale (VAS) for pain at rest and on the palpation of the uterine globe ,heart rate, blood pressure, itching, nausea, pruritus, vomiting and sedation.

Official Title
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Ultrasound Guided Quadratus Lumborum Type III Block Versus Intrathecal Morphine for Analgesia After Cesarean Delivery

Conditions
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Block

Intervention / Treatment
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* Drug: Morphine
* Drug: Quadratus lumborum block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I/II. Normal singleton pregnancy with a gestation of at least 37 weeks. Exclusion Criteria: Heart disease Coagulopathy pre-eclampsia BMI> 40 Patient refusal to undergo the Quadratus lumborum block. Allergy to local anesthetics

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: spinal morphine<br>intrathecal morphine with 10 mg bupivacaine, 5 gamma sufenta and 100 gamma morphine. Intervention: In the end of surgery a QLB block is done with 20 ml of normal saline per side. | Drug: Morphine<br>* spinal morphine is done before cesarean section<br>* Other names: spinal morphine;|
| Active Comparator: quadratus lumborum block<br>intrathecal anesthesia with10 mg bupivacaine, 5 gamma sufena and 1 ml normal saline. Procedure : a quadratus lumborum block is done with 20 ml of bupivacaine 0,125% per side. | Drug: Quadratus lumborum block<br>* a US Block QLB is done after surgery<br>* Other names: QLB;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total morphine consumption over 24 hours postoperatively | Total IV morphine used when started postoperatively using a PCA with morphine in the post anesthesia care unit until 2' hours posteratively. | Arrival to post anesthesia care unit until 24 hours posteratively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to first analgesic demand using PCA pump with morphine | recording the exact time to first analgesic demand by using the PCA with Morphine | Arrival to post anesthesia care unit until 24 hours posteratively | 
| Visual analog scale (VAS) pain scores at rest and during the palpation of the uterine globe | At predetermined intervalls, visual analog scale (VAS) pain scores at rest and at the palpation of the uterine globe were noted. | Arrival to post anesthesia care unit until 24 hours posteratively | 
| Time to first deambulaton after surgery | After surgery, time when the patient was able to move from bed was noted. | Arrival to post anesthesia care unit until 24 hours posteratively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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quadratus lumborum block, cesarean section, spinal morphine, ultrasound guidance