Analgesic Efficacy of Different Nerve Blocks in Postoperative Cesarean Section

Study Overview
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Brief Summary
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comparing analgesic efficacy of different nerve blocks on post operative cesarean sections.

Detailed Description
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Analgesic efficacy of Erector Spinae, Quadratus Lumborum and Intrathecal Morphine for post operative pain relief after cesarean section, A Prospective Randomized Single-Blind Controlled Study.

Official Title
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Analgesic Efficacy of Erector Spinae Block , Quadratus Lumborum Block and Intrathecal Morphine for Post Operative Pain Relief After Cesarean Section, A Prospective Randomized Single-Blind Controlled Study

Conditions
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Post Operative Pain

Intervention / Treatment
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* Drug: intrathecal morphine for intrathecal morphine group . bupivacaine 0.25% for Quadratus Lumborum and Erector Spinae nerve block groups .


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-40 years old more or equal 37 weeks of gestation ASA 1,2 Elective cesarean delivery Exclusion Criteria: Patient refusal inability to cooperate with or understand the study local infection. bleeding disorder known anaphylaxis to any drug used in the trial ASA physical status more than 2 emergency operations chronic opioid use (opioid use in the past 3 months) Neurologic deficit or disorder contraindication to regional anesthesia.

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Intrathcal Morphine Group<br>Intrathecal morphine administration for post operative pain relief after cesarean section | Drug: intrathecal morphine for intrathecal morphine group . bupivacaine 0.25% for Quadratus Lumborum and Erector Spinae nerve block groups .<br>* Intrathecal morphine Group: All members of this group will receive spinal anesthesia with 12 mg 0.5% (2.2ml) hyperbaric bupivicane with intrathecal morphine(100mcg). QLB Group: All members of this group will receive bilateral quadratus lumborum block after spinal anesthesia at end of operation. The QLB will be performed by using bupivacaine 0.25% .ESB Group: All members of this group will receive bilateral erector spinae block after spinal anesthesia at end of operation. The ESB will be performed by using bupivacaine 0.25% (15 ml in each side) .<br>|
| Active Comparator: Quadratus Lumborum nerve block group<br>Quadratus Lumborum nerve block administration for post operative pain relief after cesarean section | Drug: intrathecal morphine for intrathecal morphine group . bupivacaine 0.25% for Quadratus Lumborum and Erector Spinae nerve block groups .<br>* Intrathecal morphine Group: All members of this group will receive spinal anesthesia with 12 mg 0.5% (2.2ml) hyperbaric bupivicane with intrathecal morphine(100mcg). QLB Group: All members of this group will receive bilateral quadratus lumborum block after spinal anesthesia at end of operation. The QLB will be performed by using bupivacaine 0.25% .ESB Group: All members of this group will receive bilateral erector spinae block after spinal anesthesia at end of operation. The ESB will be performed by using bupivacaine 0.25% (15 ml in each side) .<br>|
| Active Comparator: Erector Spinae nerve block group<br>Erector Spinae nerve block administraion for post operative pain relief after cesarean section | Drug: intrathecal morphine for intrathecal morphine group . bupivacaine 0.25% for Quadratus Lumborum and Erector Spinae nerve block groups .<br>* Intrathecal morphine Group: All members of this group will receive spinal anesthesia with 12 mg 0.5% (2.2ml) hyperbaric bupivicane with intrathecal morphine(100mcg). QLB Group: All members of this group will receive bilateral quadratus lumborum block after spinal anesthesia at end of operation. The QLB will be performed by using bupivacaine 0.25% .ESB Group: All members of this group will receive bilateral erector spinae block after spinal anesthesia at end of operation. The ESB will be performed by using bupivacaine 0.25% (15 ml in each side) .<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of analgesia until first analgesic request. | post operative pain control. | 24 hours . | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| onset of pain . pain intensity using Numerical Analogue Score ( NRS) . ordered from 0 to 10 . 0 value indicates no pain , 10 value indicates worst pain | post operative pain control. | more or less than 2 years |