Impact of a Strategy Combining Morphine Savings and Anesthesia Technique on the Quality of Post-operative Rehabilitation

Study Overview
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Brief Summary
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The aim of REHACESAR is to study the impact of an association of a low dose of neuraxial morphine and a locoregional anesthesia (TAP block or catheter for continuous wound infiltration) on quality of recovery after cesarean delivery under regional anesthesia. To assess the quality of recovery, women complete the self-questionnaire Quality Of Recovery (QOR)15 on D-1 (the day before cesarean, if elective), D+1, +2 and +3 after surgery. The QOR-15 is a 15 items questionnaire which provides a valid and efficient evaluation of the postoperative quality of recovery. REHACESAR is a prospective observational study. It takes place in the maternity of the CHR Metz-Thionville hospital.

Detailed Description
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Cesarean delivery is a very frequent surgical procedure. In France 20,4% of all births occur by cesarean section. Regional anesthesia (Spinal or epidural anesthesia) is the most common type of anesthesia for emergent or elective cesarean section. HAS guidelines on Enhanced Recovery After Surgery (ERAS) include cesarean section. ERAS is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing surgery. The aim is to avoid factors which delay recovery: nausea and vomiting, pain, postoperative ileus… Postoperative analgesia is a key factor in ERAS because pain may prolong recovery and has a negative impact on rehabilitation. Among the multimodal analgesia we can use neuraxial morphine: epidural or intrathecal. Neuraxial morphine is effective for post-cesarean analgesia. Previous studies have attempted to determine the optimum intrathecal and epidural morphine doses. The aim is to provide the better analgesia with fewer side effects (pruritus, nausea and vomiting, ileus) Another way to provide analgesia is locoregional anesthesia: continuous wound infiltration and Transversus Abdominis Plane Block (TAP) block. The aim of REHACESAR is to study the impact of an association of a low dose of neuraxial morphine and a locoregional anesthesia (TAP block or catheter for continuous wound infiltration) on quality of recovery after cesarean delivery under regional anesthesia. To assess the quality of recovery, women complete the self-questionnaire Quality Of Recovery (QOR)15 on D-1 (the day before cesarean, if elective), D+1, +2 and +3 after surgery. The QOR-15 is a 15 items questionnaire which provides a valid and efficient evaluation of the postoperative quality of recovery. REHACESAR is a prospective observational study. It takes place in the maternity of the CHR Metz-Thionville hospital.

Official Title
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Impact of a Strategy Combining Morphine Savings and a Loco-regional Anesthesia Technique on the Quality of Post-operative Rehabilitation of Cesareans Performed Under Peri-spinal Anesthesia

Conditions
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Cesarean Section Complications

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant woman, operated on a scheduled cesarean under spinal anesthesia or urgent under epidural anesthesia, with use of perimedullary morphine Exclusion Criteria: Contraindication to the use of morphine Contraindication to local anesthetics Urgent cesarean section for maternal pathology: preeclampsia (PE), eclampsia, HELLP syndrome Post-operative maternal transfer Preoperative opiate treatment Patient unable to understand and / or answer a questionnaire in French

Ages Eligible for Study
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Minimum Age: 18 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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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of the QOR-15 D1 post-caesarean score between six different groups | The QoR 15 score is a score of 15 items, each scored from 0 to 10. These items assess 5 dimensions of post-operative recovery: pain, physical comfort, functional autonomy, emotions and psychological support. These 15 items represent the quality of post-operative rehabilitation in its physical and mental dimensions | day1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison between the different anesthesia groups of the post-operative period before resumption of gastrointestinal transit. | The corresponding criterion will be the time in hours between surgery and the resumption of a gas transit | day 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cesarean, anesthesia