NCT03199170

Effect of Bilateral Quadratus Lumborum Block for Pain Relief in Patients With Cesarean Section

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 90 (actual)
• Sponsor: Mahidol University · Academic / Other
• Sex: Female
• Age: 18 Years
• Healthy volunteers: Accepted

Summary

Cesarean section commonly induces moderate to severe pain for 48 hours. These patients have additional compelling reasons to provide adequate pain relief as early mobilization is a key factor to prevent the risk of thromboembolic event which is increased during pregnancy. Beside these, patients need to be pain free to takecare for their newborn and breastfeed them. Poorly controlled pain after cesarean section also increases risk of chronic pain and postpartum depression. Intrathecal morphine is considered the "gold standard" for postoperative pain relief after cesarean delivery. The duration of analgesic effect of morphine extend to 12-24 hours. Its widespread use is due to its favorable pharmacokinetic profile, ease of administration and low cost. Although intrathecal morphine is highly effective, its use is associated with undesirable adverse effect particularly nausea, vomiting and pruritus which reduce overall patients' satisfaction. More serious complication is the risk of delayed maternal respiratory depression. The Quadratus Lumborum block was first described in 2007 which demonstrates a spread to the paravertebral space, thus leads to a more extensive block to T5-L1 nerve branches and a long lasting block with the potential to provide visceral pain relief. Therefore, this block has an evolving role in postoperative analgesia for many lower abdominal surgeries. As the safety is concerned, there has been one report of a patient with unilateral hip flexion and knee extension weakness leading to unplanned overnight admission following lateral quadratus lumborum block after laparoscopic gynaecological operation. If the result favors effective, it will have the advantage of a combination with intrathecal opioid to prolong the pain free period after cesarean section which has about 4,000 cases per year.

Conditions

• Caesarean Section
• Spinal Anesthesia
• Quadratus Lumborum Block
• Analgesia

Interventions

Type	Name	Description
DRUG	Intrathecal morphine	0.5% Hyperbaric bupivacaine 2 ml add morphine 0.2 mg for spinal anesthesia
DRUG	Bilateral Quadratus Lumborum Block	0.25% Bupivacaine 25 ml each side for quadratus lumborum block without spinal morphine
DRUG	Intrathecal morphine with bilateral Quadratus Lumborum Block	0.5% Hyperbaric bupivacaine 2 ml add morphine 0.2 mg for spinal anesthesia and 0.25% Bupivacaine 25 ml each side for quadratus lumborum block

Timeline

• Start date: 2017-09-01
• Primary completion: 2019-01-01
• Completion: 2019-08-01
• First posted: 2017-06-26
• Last updated: 2019-09-26

Locations

1 site across 1 country: Thailand