Quadratus Lumborum Block Type 2 Versus Posterior Transversus Abdominus Plane Block (quadratus)

Mansoura University

Status: Completed

Conditions: Regional Block

Treatments: Procedure: Quadratus lumborum block type 2; Procedure: Posterior transversus abdominus plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT04773730

regional block

Details and patient eligibility

About

This patient population are at risk of adverse effects secondary to inadequate pain management such as inadequate maternal bonding and late ambulation.

Regional analgesia is preferred due to their opioid sparing effects and reduction in related adverse effects but the analgesia from these blocks is not known which one is superior to the other in the context of cesarean section

Full description

The aim of this study is to compare the effect of posterior transversus abdominus plane block and quadratus lumborum type 2 for cesarean delivery.

The transversus abdominus plane(TAP) block provides sensory block from T6 to L1 for lower abdominal surgeries.

Quadratous lumborum type 2 block, the injection is posterior to the quadratus lumborum muscle. This method has the advantage of a more superficial point of injection with better ultrasonographic resolution.

Only one RCT was done in this context by Kalpana Verma and his colleagues comparing quadratus lumborum type 2 and posterior transversus abdominus plane block. That shows marked discrepancy with time to first analgesic request from the quadratus lumborum block in other abdominal surgeries

Enrollment: 100 patients

Sex: Female

Ages: 20 to 40 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists physical status II parturient.
• Singleton pregnancies with a gestation of at least 37 weeks.
• Patients undergoing spinal anesthesia for cesarean deliveryvia a Pfannenstiel incision with exteriorization of the uterus.

Exclusion criteria

• Age < 19 or > 40 years.
• Height<150 cm, weight < 60 kg, body mass index (BMI) ≥35 kg/m2.
• Inability to comprehend or participatein pain scoring system.
• Contraindications to spinal anesthesia (Coagulopathy, increased intracranial pressure, or local skin infection).
• Hypersensitivity to any drugused in the study.
• Hypertensive disorders of pregnancy.
• Renal impairment or other contraindication to non-steroidal anti-inflammatory drugs.
• Significant cardiovascular, renal or hepatic abnormalities.
• Patients with history of opoid intake, drug abusers, psychiatric patients.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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100 participants in 2 patient groups

Posterior transversus abdominus block

Active Comparator group

Description:

After the surgery end and while the patient in the supine position, with the side to be blocked is elevated A 12-14 MHz linear array transducer will be placed transversely between the iliac crest and costal margin then slided from medial-lateral to visualize the posterior most part of the external oblique, internal oblique, and transversus abdominus muscles Then 20 mL of bupivacaine0.25% will be injected between the transverses abdominus muscle and the fascia deep to the internal oblique muscle The same steps will be repeated on the other side

Treatment:

Procedure: Posterior transversus abdominus plane block

Quadratus lumborum block type 2

Active Comparator group

Description:

After the surgery end and while the patient in the supine position, with the side to be blocked is elevated A2-5 MHz curved array transducer will be placed at the level of the antero-superior iliac spine then the external oblique muscle will be followed posterolaterally until its posterior border will be visualized The probe will be tilted down to identify a bright hyperechoic line After that 20 mL of bupivacaine 0.25% will be injected under direct visualization on the posterior surface of quadrates lumborum muscle The same steps will be repeated on the other side

Treatment:

Procedure: Quadratus lumborum block type 2