NCT03199170

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

Completed NA Last updated 26 September 2019

What this trial tests

NA trial testing Intrathecal morphine in Caesarean Section in 90 participants. Completed in 1 August 2019.

Timeline

1 September 2017

Primary endpoint
1 January 2019

1 August 2019

Quick facts

Lead sponsor	Mahidol University
Phase	NA
Status	Completed
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	triple
Primary purpose	prevention
Enrollment	90
Start date	1 September 2017
Primary completion	1 January 2019
Estimated completion	1 August 2019
Sites	1 location across Thailand

Drugs / interventions tested

• Intrathecal morphine — full drug profile →
• Bilateral Quadratus Lumborum Block — full drug profile →
• Intrathecal morphine with bilateral Quadratus Lumborum Block — full drug profile →

Conditions studied

• Caesarean Section — all drugs for Caesarean Section →
• Spinal Anesthesia — all drugs for Spinal Anesthesia →
• Quadratus Lumborum Block — all drugs for Quadratus Lumborum Block →
• Analgesia — all drugs for Analgesia →

Sponsor

Mahidol University

Who can join

18 and older, female only, with Caesarean Section or Spinal Anesthesia. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

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.

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

1. Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial.
   Pangthipampai P, Dejarkom S, Poolsuppasit S, Luansritisakul C, et al · · 2021 · cited 20× · PMID 33761894 · DOI 10.1186/s12871-021-01309-6