Analgesic Effects of Intrathecal Morphine and Bilateral Erector Spina Plane Block in Elective Cesarean Section

Study Overview
=================
Brief Summary
-----------------
Cesarean section cause severe pain due to surgical incision, abdominal wall retraction and visceral organ movements. Cesarean section can be performed with general anesthesia, spinal anesthesia, epidural anesthesia and combined spinal epidural anesthesia methods. Because of the possibility of aspiration pneumonia in pregnant women are under general anesthesia, the awareness of anesthesia in the mother during the operation due to insufficient anesthesia, unsuccessful intubation, respiratory complications in the mother and newborn and low APGAR scores, regional anesthesia is superior to general anesthesia in elective cesarean section operations. Spinal anesthesia, abdominal wall blocks such as erector spinae plane block, parenteral and intrathecal opioids may be used for postoperative analgesia in cesarean section operations. Intrathecal morphine can cause postoperative nausea-vomiting, itching, respiratory depression. Erector spina plane block can provide effective pain control and reduce opioid consumption. The primary implication of this study is to compare postoperative pain scores and opioid consumption on elective cesarean section patients under spinal anesthesia with intrathecal morphine or erector spina block in addition to spinal anesthesia.

Official Title
-----------------
Comparing of The Postoperative Analgesic Effects of Intrathecal Morphine and Ultrasound-guided Bilateral Erector Spinae Plane Block in Elective Cesarean Section Operations

Conditions
-----------------
Opioid Use, Postoperative Pain

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients between 18 and 40 years old, ASA (American Society of Anesthesiologists) score I-II, undergoing elective cesarean section Exclusion Criteria: The patients with major hepatic, cardiovascular or renal disease The patients for whom spinal anesthesia is contraindicated The patients who is allergic to any drugs that we use for this study

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Intrathecal Morphine Group<br>Prosedure/Surgery: Regional block and Intrathecal Morphine Comparison Comparing postoperative pain and opioid consumption in groups | |
| Bilateral Erector Spinae Plane Block Group<br>Prosedure/Surgery: Regional block and Intrathecal Morphine Comparison Comparing postoperative pain and opioid consumption in groups | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Scores | Comparing pain scores with Numeric Rating Scale (NRS) 0-10 | 24 hours | 
| Opioid Consumption | Comparing opioid consumption via Patient Controlled Analgesia (PCA) device | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Apgar scores of newborns | APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores may be effected by intrathecal morphine | 1st and 5th minute after the delivery | 
| Participant satisfaction | Comparing pain with numeric rating scale (NRS) | 24 hours | 
| Side effects of medications | İntravenous and intrathecal opioid can cause nausea-vomiting, respirator depression, itching | 24 hours | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
postoperative pain, opioid consumption, erector spinae plane block, intrathecal morphine