Ignite Creation Date:
2024-05-06 @ 8:27 PM
Last Modification Date:
2024-10-26 @ 3:28 PM
Study NCT ID:
NCT06393192
Status:
COMPLETED
Last Update Posted:
2024-05-01
First Post:
2024-04-27
Brief Title:
The Post Cesarean Section Analgesic Effect of Various Quadratus Lumborum Block Approaches
Sponsor:
Sohag University
Organization:
Sohag University
Study Overview
Official Title:
Postoperative Analgesic Effects of Various Quadratus Lumborum Block Approaches Following Cesarean Section
Status:
COMPLETED
Status Verified Date:
2024-04
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
included patients were divided into 4 groups and each group received a mode of post cesarian section analgesia and pain was assessed by visual analogue scale at rest and movement
1 st group epidural analgesia
2 nd group Quadratus lumborum type 2
3 rd group Quadratus lumborum type 3
4 th group Quadratus lumborum type 23
1 st group epidural analgesia
2 nd group Quadratus lumborum type 2
3 rd group Quadratus lumborum type 3
4 th group Quadratus lumborum type 23
Detailed Description:
Patients fulfilling the eligibility criteria were approached prior to delivery The attending physician explained the nature of the study and all patients signed an informed consent then patients were divided in to four groups as follows equal sample size in each group the QLB type 2 QL2 group QLB type 3 QL3 group QLB type 2 3 QL23 group and EA only group
A 16-gauge intravenous cannula pathway was established in the non-dominant hand or arm in the operation unit All parturient with standard monitoring including electrocardiogram pulse arterial oxygen saturation respiratory rate and non-invasive blood pressure NIBP was performed combined with spinal and epidural anesthesia before C-section in the left lateral position and peripheral nerve block at the end of surgery by an experienced doctor AMA The epidural needle was inserted into the lumbar epidural space at the level of L2-3 intervertebral space
After finding the epidural space using loss of resistance to saline technique the tip of a spinal needle passed through the epidural needle To achieve a sensory block height to the level of the sixth thoracic dermatome every parturient received intrathecal anesthesia of 075 bupivacaine 13-17 mL Then the needle was withdrawn and then an epidural catheter was inserted through the epidural needle in case the failure of intrathecal anesthesia All surgical treatments were performed successfully in the usual manner
Immediately after surgery all subjects were transferred to the post-anesthesia care unit PACU and administered pre-determined analgesia All parturient were lift in the supine position tilting 45 degrees to the opposed side in order to place the low-frequency convex probe properly and see the sonography clearly Bilateral QLB was performed using the atraumatic needle 22-G 120-mm needle for peripheral nerve blocks advanced in-plane under the guidance of an ultrasound machine The ultrasonogram of the abdominal wall was displayed clearly through probe moving or tilting Pillows helped to relieve the tension along the abdominal wall of parturient The whole procedure was performed strictly according to clinical protocol
In this study QL2 or QL3 were conducted through an anterolateral approach with the supine position as mentioned in Sato et al 2017 The ultrasound transducer was placed transversely on both flanks at the horizontal level of L2-3 and adjusted until the Shamrock sign formed of QL muscle psoas major and erector spinae was visualized with imaging depth set between 0 and 99 cm Needles will be penetrated in an anterolateral to posteromedial direction Local anesthetic will be injected posterior to QL muscle in QL2 while in QL3 it will be located between QL muscle and psoas major QL23 block was conducted in the same plane with only one puncture on each side
QL2 and QL3 groups received 02 ropivacaine at 30 mL at the sites mentioned above in each side for a total of 60 mL For QL23 group they recieved 02 ropivacaine 15 mL at each point of injection with the needle inserting only once in each side The solution was injected after negative aspiration to exclude vascular puncture As for the EA group we used a single bolus of 6 mL saline solution containing 9 mg ropivacaine 015 and 2 mg morphine via the epidural catheter as postoperative analgesia and meanwhile they received a procedure like QL2 but only saline was injected as placebo
Epidural catheters were detached from all parturient after the procedure mentioned above Parturient received a standard postoperative analgesic regime of regular oral paracetamol 10 g 6 hourly
A 16-gauge intravenous cannula pathway was established in the non-dominant hand or arm in the operation unit All parturient with standard monitoring including electrocardiogram pulse arterial oxygen saturation respiratory rate and non-invasive blood pressure NIBP was performed combined with spinal and epidural anesthesia before C-section in the left lateral position and peripheral nerve block at the end of surgery by an experienced doctor AMA The epidural needle was inserted into the lumbar epidural space at the level of L2-3 intervertebral space
After finding the epidural space using loss of resistance to saline technique the tip of a spinal needle passed through the epidural needle To achieve a sensory block height to the level of the sixth thoracic dermatome every parturient received intrathecal anesthesia of 075 bupivacaine 13-17 mL Then the needle was withdrawn and then an epidural catheter was inserted through the epidural needle in case the failure of intrathecal anesthesia All surgical treatments were performed successfully in the usual manner
Immediately after surgery all subjects were transferred to the post-anesthesia care unit PACU and administered pre-determined analgesia All parturient were lift in the supine position tilting 45 degrees to the opposed side in order to place the low-frequency convex probe properly and see the sonography clearly Bilateral QLB was performed using the atraumatic needle 22-G 120-mm needle for peripheral nerve blocks advanced in-plane under the guidance of an ultrasound machine The ultrasonogram of the abdominal wall was displayed clearly through probe moving or tilting Pillows helped to relieve the tension along the abdominal wall of parturient The whole procedure was performed strictly according to clinical protocol
In this study QL2 or QL3 were conducted through an anterolateral approach with the supine position as mentioned in Sato et al 2017 The ultrasound transducer was placed transversely on both flanks at the horizontal level of L2-3 and adjusted until the Shamrock sign formed of QL muscle psoas major and erector spinae was visualized with imaging depth set between 0 and 99 cm Needles will be penetrated in an anterolateral to posteromedial direction Local anesthetic will be injected posterior to QL muscle in QL2 while in QL3 it will be located between QL muscle and psoas major QL23 block was conducted in the same plane with only one puncture on each side
QL2 and QL3 groups received 02 ropivacaine at 30 mL at the sites mentioned above in each side for a total of 60 mL For QL23 group they recieved 02 ropivacaine 15 mL at each point of injection with the needle inserting only once in each side The solution was injected after negative aspiration to exclude vascular puncture As for the EA group we used a single bolus of 6 mL saline solution containing 9 mg ropivacaine 015 and 2 mg morphine via the epidural catheter as postoperative analgesia and meanwhile they received a procedure like QL2 but only saline was injected as placebo
Epidural catheters were detached from all parturient after the procedure mentioned above Parturient received a standard postoperative analgesic regime of regular oral paracetamol 10 g 6 hourly
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None