Segmental Thoracic vs Lumbar Spinal: Recovery After Elective Cesarean
Effect of Thoracic Segmental Spinal Anesthesia Versus Conventional Lumbar Spinal Anesthesia on Early Mobilization and Obstetric Quality of Recovery in Elective Cesarean Delivery: A Randomized Controlled Trial
This randomized controlled trial compares thoracic segmental spinal anesthesia (T10-11) with conventional lumbar spinal anesthesia (L4-5) in patients undergoing elective cesarean section. The primary outcome is postoperative quality of recovery assessed with the ObsQoR-11 score. Secondary outcomes include block characteristics (onset time, number of blocked dermatomes, presence of sacral sparing, and postoperative motor block assessed with the Bromage scale), hemodynamic parameters, vasopressor and anticholinergic requirements, perioperative complications, and time to first mobilization.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
Cesarean delivery is most commonly performed under lumbar spinal anesthesia. Thoracic segmental spinal anesthesia, performed at a higher interspace, may produce a more segmental block with less lower-limb motor involvement. Evidence in obstetric patients is limited. This trial will test whether the level of spinal injection, with agent, dose, and volume held constant, affects postoperative recovery after elective cesarean delivery.
Prospective, single-center, two-arm, parallel-group randomized controlled trial, 1:1 allocation. (Computer-generated block randomization) Patients and outcome assessors will be masked to allocation; the anesthesiologist performing the block cannot be masked.
All patients will receive isobaric bupivacaine 0.5% 1.5 mL (7.5 mg) with fentanyl 25 mcg (0.5 mL), total volume 2 mL, identical in both arms. Lumbar arm: L4-5 interspace. Thoracic arm: T10-11 interspace. The level will be identified by landmark technique with the patient in the sitting position, using a 26 G pencil-point spinal needle.
Spinal success will be tested by sensory and motor examination. Sensory block (onset, blocked dermatomes, sacral sparing) will be tested with pinprick, and motor block with the modified Bromage scale. Surgery will start when the block reaches T5. In case of a patchy block or inadequate sensory level, conversion to general anesthesia is planned.
Patients will be monitored with standard ASA monitoring. Hypotension will be defined as mean arterial pressure below 60 mmHg or a decrease of more than 20% from baseline, and will be treated with ephedrine 5 mg IV boluses. Bradycardia will be defined as a heart rate below 50 beats/min and will be treated with atropine 0.5 mg IV. Fluid replacement, antiemetic prophylaxis, postoperative analgesia, and the mobilization protocol will be identical in both arms.
Studietype
Inschrijving (Geschat)
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
- Naam: NEZİR YILMAZ, Associate Professor
- Telefoonnummer: 05068939496
- E-mail: yilmaznezir@hotmail.com
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Pregnant women scheduled for elective cesarean section
- ASA II-III
- Age 18-45 years
Exclusion Criteria:
- Contraindications to spinal anesthesia
- Coagulopathy or anticoagulant use
- Infection at puncture site
- Severe cardiac disease
- Patient refusal
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Experimenteel: Thoracic segmental spinal anesthesia
Participants allocated to this arm will receive spinal anesthesia at the T10-11 interspace for elective cesarean delivery. After injection, onset time of the block, the number of blocked dermatomes, and the presence or absence of sacral sparing will be recorded, and motor block will be assessed with the modified Bromage scale at predefined intervals during the first 24 postoperative hours . All procedures will be performed by experienced anesthesiologists under standard monitoring. Fluid co-loading, hypotension and bradycardia thresholds with the corresponding vasopressor and atropine |
Spinal anesthesia will be performed at the thoracic interspace (T10-11) |
|
Actieve vergelijker: Lumbar Spinal Anesthesia
Lumbar Spinal Anesthesia Participants in this group will receive conventional spinal anesthesia performed at the lumbar interspace Procedure/Surgery: Lumbar Spinal Anesthesia- (L4-5). The goal is to achieve a standard sensory block level adequate for cesarean delivery. All procedures will be performed by experienced anesthesiologists under standardized conditions. Intraoperative management, including hemodynamic support and fluid administration, will follow the same institutional protocol as in the thoracic group. |
Participants in this group will receive conventional spinal anesthesia performed at the lumbar interspace ( L4-5) |
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Obstetric Quality of Recovery-11 score
Tijdsspanne: at Postoperative 24th hours
|
Quality of recovery was assessed using the Obstetric Quality of Recovery-11 (ObsQoR-11) questionnaire. Each item is scored from 0 to 10, yielding a total score ranging from 0 to 110, where 110 indicates the best possible recovery and 0 indicates the worst. |
at Postoperative 24th hours
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Mean arterial pressure
Tijdsspanne: 0, 5, 15, 30, 45 minutes intraoperatively
|
Mean arterial pressure (MAP), defined as the time-weighted average arterial pressure over a single cardiac cycle, was calculated using the standard formula: MAP = [(2 × diastolic blood pressure) + systolic blood pressure] / 3. Continuous or intermittent MAP measurements were used to assess hemodynamic stability and adequacy of organ perfusion throughout the perioperative period. Intraoperative hypotension was predefined as a MAP <6o mmHg. |
0, 5, 15, 30, 45 minutes intraoperatively
|
|
Heart rate
Tijdsspanne: 0. - 5. - 15. - 30. - 45. minutes intraoperatively
|
Heart rate (HR), expressed as beats per minute (bpm), was continuously monitored using standard electrocardiography. HR was used as an indicator of autonomic and hemodynamic response throughout the perioperative period. Tachycardia was predefined as HR >100 bpm and bradycardia as HR <50 bpm. |
0. - 5. - 15. - 30. - 45. minutes intraoperatively
|
|
Onset time of sensory block
Tijdsspanne: Within 15 minutes after completion of intrathecal injection
|
Time from completion of intrathecal injection to loss of sensation to pinprick at the [ T4] dermatome, assessed every 1 minute until the level is reached. |
Within 15 minutes after completion of intrathecal injection
|
|
Number of blocked dermatomes
Tijdsspanne: 15 minutes after completion of intrathecal injection.
|
Highest and lowest blocked dermatome levels assessed by pinprick testing, and the total number of blocked dermatomes calculated from them. |
15 minutes after completion of intrathecal injection.
|
|
Motor block (modified Bromage scale)
Tijdsspanne: 1, 2, 4, 6, 12 and 24 hours after surgery
|
Motor block will be assessed with the modified Bromage scale (0 = able to raise the extended leg; 1 = unable to raise the extended leg but able to flex the knee; 2 = unable to flex the knee but able to move the foot; 3 = unable to move the leg or foot). |
1, 2, 4, 6, 12 and 24 hours after surgery
|
|
VAS scores
Tijdsspanne: 1, 2, 4, 6, 12 and 24 hours after surgery
|
Numeric rating scale (0-10) pain scores at rest and on movement. 0 refer no pain and 10 refer the worst pain |
1, 2, 4, 6, 12 and 24 hours after surgery
|
Medewerkers en onderzoekers
Studie record data
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Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
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Meer informatie
Termen gerelateerd aan deze studie
Andere studie-ID-nummers
- ADYU-ANS-NY-016
Plan Individuele Deelnemersgegevens (IPD)
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