Comparison Between Ultrasound-guided Ilioinguinal, Iliohypogastric Nerve Blocks, TAP Block and Quadratus Lumborum Block in Patients Scheduled for Lower Segment Ceserian Sections.

NCT05617482 | Unknown

• 1 other identifier: 35633/8/22
• Study Type: interventional
• Target: 150
• Locations: 0 countries
• Sites: N/A

Brief Summary

To compare between Ultrasound guided ilioinguinal, iliohypogastric nerve blocks, TAP block and Quadratus lumborum block in patients scheduled for lower segment ceserian sections.

Conditions

Analgesia

Outcome Measures

Primary Outcomes (6)

• The quality of analgesia

  The quality of analgesia was assessed by NRS (unidimensional 11-point pain scale ranging from 0 to 10 with 0 no pain, 10 being severe pain, and the patients will be asked to mark the pain score on the scale)

  2 hours postoperatively

• The quality of analgesia

  The quality of analgesia was assessed by NRS (unidimensional 11-point pain scale ranging from 0 to 10 with 0 no pain, 10 being severe pain, and the patients will be asked to mark the pain score on the scale)

  4 hours postoperatively

• The quality of analgesia

  The quality of analgesia was assessed by NRS (unidimensional 11-point pain scale ranging from 0 to 10 with 0 no pain, 10 being severe pain, and the patients will be asked to mark the pain score on the scale)

  6 hours postoperatively

• The quality of analgesia

  The quality of analgesia was assessed by NRS (unidimensional 11-point pain scale ranging from 0 to 10 with 0 no pain, 10 being severe pain, and the patients will be asked to mark the pain score on the scale)

  10 hours postoperatively

• The quality of analgesia

  The quality of analgesia was assessed by NRS (unidimensional 11-point pain scale ranging from 0 to 10 with 0 no pain, 10 being severe pain, and the patients will be asked to mark the pain score on the scale)

  12 hours postoperatively

• The quality of analgesia

  The quality of analgesia was assessed by NRS (unidimensional 11-point pain scale ranging from 0 to 10 with 0 no pain, 10 being severe pain, and the patients will be asked to mark the pain score on the scale)

  24 hours postoperatively

Study Arms (3)

Ultrasound guided ilioinguinal, iliohypogastric TAP block

ACTIVE COMPARATOR

In ilioinguinal-iliohypogastric block group, the probe will be placed medial to the lateral one-third of the line joining the umbilicus and the anterior superior iliac spine (ASIS). The anterior superior iliac crest, iliacus muscle, internal oblique, transverses abdominis, and the ILIH nerves between them will be identified. After appreciating the sonoanatomy, the ILIH nerve will be approached with the 23-gauge Quincke spinal needle through in-plane technique and 10 ml of 0.25% bupivacaine will be injected all around and the drug spread will be appreciated.

Other: General anesthesia; Other: Ilioinguinal, iliohypogastric nerve blocks

Ultrasound guided transversus abdominis plane block

ACTIVE COMPARATOR

The transducer will be placed at between the lower rib margin and the iliac crest, the 23-gauge Quincke spinal needle needle passed through the external oblique and internal oblique muscle till reaching the transversus abdominis sheet. 20 ml of 0.25% bupivacaine will be injected

Other: General anesthesia; Other: TAP block

Ultrasound guidedQuadratus lumborum block

ACTIVE COMPARATOR

The transducer will be placed at the level of the anterosuperior iliac spine and will move cranially until the 3 abdominal wall muscles will be clearly identified. The external oblique muscle will be followed posterolaterally until its posterior border was visualized (hook sign), leaving underneath the internal oblique muscle, like a roof over the quadratus lumborum muscle. The probe will be tilted down to identify a bright hyperechoic line that corresponded with the middle layer of he thoracolumbar fascia. The needle (21 gauge) will be inserted in plane from anterolateral to posteromedial. The optimal point of injection for the QL block will be determined over the lumbar interfacial triangle using hydrodissection.

Other: General anesthesia; Other: Quadratus lumborum block

Interventions

General anesthesia OTHER

All patients undergoing ceaserian section under general anesthesia

Ultrasound guided ilioinguinal, iliohypogastric TAP block; Ultrasound guided transversus abdominis plane block; Ultrasound guidedQuadratus lumborum block

Ilioinguinal, iliohypogastric nerve blocks OTHER

In ilioinguinal-iliohypogastric block group, the probe will be placed medial to the lateral one-third of the line joining the umbilicus and the anterior superior iliac spine (ASIS). The anterior superior iliac crest, iliacus muscle, internal oblique, transverses abdominis, and the ILIH nerves between them will be identified. After appreciating the sonoanatomy, the ILIH nerve will be approached with the 23-gauge Quincke spinal needle through in-plane technique and 10 ml of 0.25% bupivacaine will be injected all around and the drug spread will be appreciated.

Ultrasound guided ilioinguinal, iliohypogastric TAP block

TAP block OTHER

In TAP block group, the probe will be placed perpendicular to the mid-axillary line between the iliac crest and the subcostal margin and the three abdominal muscle layers will be identified, and the transverses abdominis plane will be located between the internal oblique and the transverse abdominis muscle. The TAP will be approached through in-plane technique using a 23-gauge Quincke spinal needle attached to a 20 ml syringe of 0.25% bupivacaine will be injected and the drug spread in the plane will be observed.

Ultrasound guided transversus abdominis plane block

Quadratus lumborum block OTHER

For the QLB, the transducer will be placed at the level of the anterosuperior iliac spine and will move cranially until the 3 abdominal wall muscles will be clearly identified. The external oblique muscle will be followed posterolaterally until its posterior border was visualized (hook sign), leaving underneath the internal oblique muscle, like a roof over the quadratus lumborum muscle. The probe will be tilted down to identify a bright hyperechoic line that corresponded with the middle layer of he thoracolumbar fascia. The needle (21 gauge) will be inserted in plane from anterolateral to posteromedial. The optimal point of injection for the QL block will be determined over the lumbar interfacial triangle using hydrodissection.

Ultrasound guidedQuadratus lumborum block

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• American Society of Anesthesiologists physical status 1 and 2
• Aged between 18 and 45 years
• Scheduled for emergency or elective lower segment cesarean section

You may not qualify if:

• Pregnant women who will refuse to participate.
• Known allergy to local anesthetic.
• Infection at the block site.

Sponsors & Collaborators

• Tanta University: lead

MeSH Terms

Conditions

Agnosia

Interventions

Anesthesia, General

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anesthesia; Anesthesia and Analgesia

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: All patients will be informed about the three tyoes of nerve blocks; the ultrasound guided ilioinguinal, iliohypogastric nerve blocks, TAP block and quadratus lumborum block. and will sign that they agree to have any one of them according to randomization. Also the outcome assessor will be unaware about the type of nerve block given to the patient.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate professor

Study Record Dates

• First Submitted: November 7, 2022
• First Posted: November 15, 2022
• Study Start: December 1, 2022
• Primary Completion: March 1, 2023
• Study Completion: March 1, 2023
• Last Updated: November 15, 2022

Record last verified: 2022-11