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- Klinische proef NCT03673280
Quadratus Lumborum in Cesarean Section Trial (QUALICS)
Comparison Between Intrathecal Morphine and Quadratus Lumborum Block for Postpartum Analgesia of Elective Cesareans.
Postoperative pain of a caesarean section may be of high intensity, especially in the first 48 hours after the procedure, which affects the mother / newborn relationship, in addition to having the potential to progress to chronic pain. The use of intrathecal morphine is effective in post-caesarean analgesia, but carries unwanted side effects, including nausea, vomiting, urinary retention and pruritus. Therefore, alternative techniques of analgesia become necessary.
First described in 2007, ultrasound-guided quadratus lumborum (QL) block has gained prominence due to its analgesic superiority to the TAP block. Besides providing somatic analgesia, it also seems to inhibit visceral pain because the local anesthetic reaches the paravertebral space, this was observed by magnetic resonance imaging with contrast medium injected at the QL block site.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
C-section is one of the most performed surgical procedures in the world, and presents great potential for postoperative pain, especially in the first 48 hours. Pain in this period represents a risk for evolution to chronic pain, but its incidence is still very divergent when comparing the studies, ranging from 1% to 18%.
The use of intrathecal morphine (MIT) is consecrated as a first-choice method of analgesia for post-partum cesarean delivery; however, its use carries relevant side effects for the puerpera, such as pruritus, nausea, urinary retention and , more rarely, respiratory depression. In the last decade, new adjunctive forms of postoperative analgesia have become more popular, such as regional blockades, highlighting the blockage of the Transversus Abdominis plane block (TAP) and the Quadratus Lumborum block (QL), taking as benefits the prolonged analgesia they provide and the low incidence of side effects. Another factor that contributes to the popularization of regional blocks is the increasing availability of ultrasound devices in the anesthetic-surgical environment. Studies evaluating TAP block after cesarean section performed under spinal anesthesia have shown a discrete benefit in decreasing postoperative opioid consumption in addition to improving pain scores. When comparing MIT with TAP block, the superiority of MIT is due to visceral analgesia while TAP block is restricted to abdominal wall analgesia.
Ultrasound-guided Lumbar Quadrant blockade has gained prominence due to its analgesic superiority over the TAP block, because in addition to providing somatic analgesia it also seems to inhibit visceral pain since the local anesthetic reaches the paravertebral space, this was observed by magnetic resonance imaging with contrast injected at the site of the QL block.
Reviewing the literature in 2018, there are no clinical trials comparing the use of intrathecal morphine with the quadratus lumborum block.
Studietype
Inschrijving (Verwacht)
Fase
- Niet toepasbaar
Contacten en locaties
Studie Locaties
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São Paulo, Brazilië, 05403000
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Minimum age of 18 years
- Minimum gestational age of 37 weeks with a single fetus
- Patients scheduled for elective cesarean section
Exclusion Criteria:
- Clinical contraindication to spinal anesthesia
- Morbid obesity (BMI> 35kg / m²)
- Drug addiction
- Chronic use of opioids or benzodiazepines
- Inability to understand or handle the PCA pump
- Allergy to any medication included in the protocol
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Ondersteunende zorg
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verdrievoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Placebo-vergelijker: Classical spinal anesthesia
Patients allocated to this group will receive spinal anesthesia with bupivacaine 12.5mg, Fentanyl 20mcg and Morphine 80mcg + placebo quadratus lumborum block.
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Instead of using morphine in the classical spinal anaesthesia we will be performing in the experimental group the Quadratus Lumborum Block
Andere namen:
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Experimenteel: Spinal anaesthesia with block
Patients allocated to this group will receive spinal anesthesia with bupivacaine 12.5mg, Fentanyl 20mcg + quadratus lumborum block.
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Instead of using morphine in the classical spinal anaesthesia we will be performing in the experimental group the Quadratus Lumborum Block
Andere namen:
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Experimenteel: Classical anaesthesia plus block
Patients allocated to this group will receive spinal anesthesia with bupivacaine 12.5mg, Fentanyl 20mcg and Morphine 80mcg + quadratus lumborum block.
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Instead of using morphine in the classical spinal anaesthesia we will be performing in the experimental group the Quadratus Lumborum Block
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Morphine consumption
Tijdsspanne: 24 hours
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Evaluate pain in the postoperative period with to the consumption of morphine through PCA (patient controlled analgesia) pump.
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24 hours
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Pain intensity
Tijdsspanne: 24 hours
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Verbal numeric scale
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24 hours
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Nausea and Vomiting
Tijdsspanne: 24 hours
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Evaluate the incidence of nausea and vomiting between the groups through referred nausea scale from none, mild, moderate or severe.
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24 hours
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Pruritus
Tijdsspanne: 24 hours
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Evaluate the incidence of pruritus between the groups through pruritus referred scale from none, mild, moderate or severe.
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24 hours
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Chronic pain
Tijdsspanne: 3 months
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Evaluate the incidence of chronic pain between the groups through patient referred presence or absence of pain.
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3 months
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Urinary retention
Tijdsspanne: 24 hours
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Evaluate the incidence of urinary retention between the groups through patient referred presence or absence of urinary retention.
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24 hours
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Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Hermann S Fernandes, MD, University of Sao Paulo
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Verwacht)
Studie voltooiing (Verwacht)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- CAAE 90600818.0.0000.0068
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
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Klinische onderzoeken op Quadratus Lumborum Block
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Assiut UniversityVoltooid
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Alexandria UniversityVoltooidTransmusculaire Quadratus Lumborum Block HeupoperatieEgypte
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CHU de ReimsVoltooidTotale heupvervangende operatieFrankrijk
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Ain Shams UniversityVoltooid
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Riphah International UniversityWervingInnominate Upslip Suprapubische disfunctiePakistan
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Ain Shams UniversityWerving
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The General Authority for Teaching Hospitals and...VoltooidQuadratus Lumborum-blok Type III Versus Type II Versus Transversus Abdominis Vlakblok in keizersnedeKeizersnede | Quadratus Lumborum-blok | Transversus Abdominis-vlakblokEgypte
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Federal University of São PauloIrmandade da Santa Casa de Misericordia de Sao PauloOnbekend
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Sohag UniversityVoltooidEpidurale analgesie | Keizersnede | Pijnloze arbeidEgypte