Quadratus Lumborum Block vs Tranversus Abdominis Plane Block for Cesarean Section
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|ClinicalTrials.gov Identifier: NCT02489851|
Recruitment Status : Completed
First Posted : July 3, 2015
Last Update Posted : May 24, 2016
The Quadratus Lumborum block (QLB) was first described by Blanco in 2007. The main advantage of QLB compared to the Transversus Abdominis Plane block (TAP) is the extension of local anesthetic agent beyond the TAP plane to the thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution.
Previous studies showed that both TAP block and QLB may reduce morphine requirements in the postoperative period in patients who had cesarean section under spinal anaesthesia. However there are no published reports comparing the 2 techniques.
The aim of this randomised controlled, double blinded study is to compare the analgesic efficacy of QLB compared to TAP block in patients who had cesarean section under spinal anesthesia.
|Condition or disease||Intervention/treatment||Phase|
|Postoperative Pain||Procedure: Quadratus Lumborum block Procedure: Tranversus Abdominis plane block||Not Applicable|
After ethical committee approval, informed written consent will be obtained from all patients. A Sample size of 72 patients (36 per group) was calculated based on 15% reduction in morphine consumption with 0.05% significance and a power of 0.8.
Consenting patients scheduled to have elective cesarean section under spinal anesthesia will be randomised to receive bilateral QLB or TAP at the end of surgery.The dose of local anaesthetic in both groups will be 0.2 ml/kg 0.125% Bupivacaine. Allocation to either group will be done using closed envelope technique.
All the blocks will be performed in operation theatre after the end of cesarean section with intravenous access, ECG, BP, oxygen saturation by pulse oximetry monitoring and full resuscitation equipment and medication ready.
All patients will be in the supine position . Under ultrasound guidance a 22 Gauge, two inch Pajunk Sonoplex needle will be used for both techniques. The calculated dose of local anaeshetic will be injected bilateraly with intermittent aspiration. The spread of injectate will be seed on ultrasound.
All patients will receive the routine postoperative analgesia, comprising patient-controlled IV morphine analgesia and regular diclofenac and paracetamol.
All patients will be assessed postoperatively by a blinded investigator: in the postanesthesia care unit and at 2, 4, 6, 12, 24, 36, and 48 h postoperatively.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||76 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Official Title:||Quadratus Lumborum Block vs Tranversus Abdominis Plane Block for Post Cesarean Section Analgesia. A Randomised Controlled Study|
|Study Start Date :||June 2015|
|Actual Primary Completion Date :||December 2015|
|Actual Study Completion Date :||December 2015|
Active Comparator: Quadratus Lumborum block group
Quadratus Lumborum block group (QL)
patients will receive a bilateral Quadratus Lumborum block using Bupivicaine 0.125%
Procedure: Quadratus Lumborum block
0.2 ml/kg bupivicaine 0.125% injected bilateraly at the posterior border of the quadratus Lumborum muscle
Other Name: QLB
Active Comparator: Transversus abdominis plane block group
Transversus abdominis plane block (TAP)
patients will receive a bilateral TAP block using Bupivicaine 0.125%
Procedure: Tranversus Abdominis plane block
0.2 ml/kg bupivicaine 0.125% injected bilateraly between internal oblique and transversus abdominis muscles.
Other Name: TAP
- Total morphine used in the first 48 hours after surgery [ Time Frame: 48 hours ]Total cumulative morphine dose in mg used in the first 48 hours after surgery
- Severity of postoperative pain via visual analogue pain scale (VAS) [ Time Frame: 48 hours ]VAS range from 0 for no pain to 10 for worst pain imaginable
- Nausea or vomiting [ Time Frame: 48 hours ]
0 = No Nausea
- = Mild Nausea.
- = Moderate
- = Severe Nausea or Vomiting
- Sedation score [ Time Frame: 48 hours ]
- = drowsy but responds to normal verbal communication.
- = asleep, but awakes with verbal communication.
- = asleep, awakens with mild physical stimulation.
- = asleep, unresponsive to mild physical stimulation.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02489851
|United Arab Emirates|
|Abu Dhabi, United Arab Emirates, 3788|
|Principal Investigator:||Rafa Blanco, FRCA||Corniche Hospital|
|Principal Investigator:||Tarek Ansari, FFARCSI||Corniche Hospital|
|Principal Investigator:||Nanda Shetty, MD||Corniche Hospital|