Quadratus Lumborum Block Type III Versus Type II Versus Transversus Abdominis Plane Block in Cesarean Section

Study Overview
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Brief Summary
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Compare the type III and type II quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) regarding efficacy in CS

Detailed Description
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The transversus abdominis plane block (TAPB) is administered between the internal oblique muscle and the transversus abdominis muscle in the fascial plane, directly pointing to the somatic nerves T6-L1 that run in this plane. In addition, meta-analyses demonstrate that it is an effective analgesic for somatic pain and diminishes opiate intake. It has been reported that TAPB is an efficient analgesic approach following cesarean section . The quadratus lumborum (QL) muscle block (QLB) is a fascial plane block as local anesthetic (LA) is introduced nearby to the QL muscle to numb the thoracolumbar nerves. QLB is categorized into four types according to drug administration location, I (lateral), II (posterior), III (anterior/transmuscular), and Intravenous, (intramuscular). QLB can effectively decrease both visceral and somatic pain by LA distribution to the thoracic paravertebral space (TPVS), as this block ensures effective pain control from the T7 to L1 dermatomes. QLB is one of the regional techniques that provides the greatest benefit in post-CS pain control, as it is progressively applied in obstetric anesthetic precise to improve analgesic results.

Official Title
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Efficacy of Quadratus Lumborum Block Type III Versus Type II Versus Transversus Abdominis Plane Block in Cesarean Section: A Randomized Controlled Multicenter Trial

Conditions
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Quadratus Lumborum Block, Cesarean Section, Transversus Abdominis Plane Block

Intervention / Treatment
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* Procedure: Quadratus lumborum block typen II
* Procedure: Quadratus lumborum block III
* Procedure: Transversus abdominis plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists (ASA) physical status II aged 18 to 40 years old presenting for elective Cesarean section Exclusion Criteria: body mass index (BMI) ≥40 kg/m2 weight < 50kg height < 150 cm contraindications for the use of active labor, spinal anesthesia recent opiate intake hypersensitivity to any used medication substantial cardiovascular diseases renal diseases hepatic, diseases.

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: Quadratus lumborum block type II<br>A 22 gauge needle was positioned between the erector spinae muscle in the thoracolumbar fascia's middle layer | Procedure: Quadratus lumborum block typen II<br>* A 22 gauge needle was positioned between the quadratus lumborum muscle posterior border and the erector spinae muscle in the thoracolumbar fascia's middle layer<br>|
| Active Comparator: Quadratus lumborum block type III<br>A 22 gauge needle was positioned between the psoas and quadratus lumborum muscles at the anterior fascia lumbosacral | Procedure: Quadratus lumborum block III<br>* A 22 gauge needle was positioned between the psoas and quadratus lumborum muscles at the anterior fascia lumbosacral<br>|
| Active Comparator: Transversus abdominis plane block<br>A 22 gauge needle was positioned between the internal oblique and transversus abdominis muscles | Procedure: Transversus abdominis plane block<br>* A 22 gauge needle was positioned between the internal oblique and transversus abdominis muscles<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total postoperative consumed pethidine | Numerical rating scales (NRS) score was evaluated at Post Anesthesia Care Unit (PACU), 2, 4, 6, 8, 12, 18, and 24 hours as as 0 is no pain and 10 is the worst pain imaginable. If the NRS score remained ≥ 4, we provided a bolus pethidine (0.5 mg/kg intravenous) and repeatable after 30 minutes if NRS remains≥ 4. | 24 hour postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of the first analgesic request | If the Numerical rating scales (NRS) score remained ≥ 4, we provided a bolus pethidine (0.5 mg/kg intravenous). | 24 hour postoperatively | 
| Patient satisfaction | The level of patient satisfaction was graded on a 5-point Likert scale as 0= extremely dissatisfied, 1= dissatisfied, 2= neither satisfied nor dissatisfied, 3= satisfied, 4= extremely satisfied | 24 hour postoperatively | 
| The degree of postoperative pain | Numerical rating scales (NRS ) score was evaluated at Post Anesthesia Care Unit (PACU), 2, 4, 6, 8, 12, 18, and 24 hours as as 0 is no pain and 10 is the worst pain imaginable. | 24 hour postoperatively |