NCT05254093

Anterior Quadratus Lumborum Block Versus Erector Spinae Plane Block After Elective Cesarean Section

Completed NA Last updated 26 July 2022

What this trial tests

NA trial testing Quadratus lumborum block in Cesarean Section in 153 participants. Completed in 16 July 2022.

Timeline

1 March 2022

Primary endpoint
15 July 2022

16 July 2022

Quick facts

Lead sponsor	Kasr El Aini Hospital
Phase	NA
Status	Completed
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	triple
Primary purpose	prevention
Enrollment	153
Start date	1 March 2022
Primary completion	15 July 2022
Estimated completion	16 July 2022
Sites	1 location across Egypt

Drugs / interventions tested

• Quadratus lumborum block — full drug profile →
• erector spinae plane block — full drug profile →

Conditions studied

• Cesarean Section — all drugs for Cesarean Section →
• Postoperative Analgesia — all drugs for Postoperative Analgesia →

Sponsor

Kasr El Aini Hospital

Who can join

Adults 18 to 40, female only, with Cesarean Section or Postoperative Analgesia. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Cesarean section is the one of the most common surgical procedures. Inadequate pain management is associated with increased morbidity, costs, and maternal dissatisfaction. Furthermore, effective postoperative pain management enables mothers to care for their newborn infants. Systemic and neuraxial opioids are the cornerstone of postoperative pain management; however, opioids are associated with significant side effect such as respiratory depression, urine retention, constipation, and itching. To reduce the postoperative opioids requirement and subsequently their side effects, multimodal regimen is advice including neuraxial anesthesia, neuraxial morphine, regular administration of non-opioids analgesia (non-steroidal anti-inflammatory drugs and acetaminophen) and planned use of opioid for breakthrough pain.

The addition of peripheral nerve blocks to the multimodal analgesic plan was found to reduced postoperative opioids requirement in non-obstetric procedures.

Quadratus lumborum (QLB) and erector spinae plane (ESPB) blocks are relatively new techniques for peripheral nerve block and showed promising results in managing pain after Cesarean delivery.

There are several types of QLB that had been described. Lateral (QLB1), posterior (QLB2), and anterior (QLB3) quadratus lumborum blocks been studied in cesarean delivery and were found to reduce opioids requirement when compared against placebo. Cadaver studies suggest that local anesthetic deposition at QLB1 diffuses mainly to the transversus abdominis muscle plane while, at QLB2, and at QLB3 spread may occur into the thoracic paravertebral space providing additional visceral pain control.

ESPB can provide both visceral and somatic analgesia due to anterior spread to the paravertebral space. ESPB was found to reduce postoperative opioids requirement in comparison to transversus abdominis plane block and intrathecal morphine.

To the best of our knowledge, there is no published data comparing the analgesic effect of QLB3 (anterior QL) and ESPB after elective cesarean delivery.

Publications & conference data

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

1. The analgesic effect of transmuscular quadratus lumborum block versus erector spinae plane block for women undergoing elective Caesarean section: A randomized controlled trial.
   Mostafa M, Nasr MA, Fawzy M, Awad AE, et al · · 2023 · cited 9× · PMID 38107753 · DOI 10.1177/20494637231181513