TAP vs QLB in Patients After Cesarean Delivery

Written consent will be obtained before the cesarean section. Only subarachnoidally anesthetized patients may participate in the study. Pencil-point spinal needle and bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used.

At the end of surgery ultrasound-guided regional block will be performed. Each patient will be randomly allocated to one of the treated group: transversus abdominis plane block (TAP) or quadratus lumborum (QL). Patients receive 0.2 mL of local anesthetic solution (0.375 % ropivacaine) on each side.

Postoperative pain will be measured with VAS (visual-analog scale) 2, 4, 8, 12 and 24 hours after the end of the operation.

Paracetamol, metamizole, ketoprofen may be given as required. Whenever pain exceeds 40 (VAS) 5 mg of morphine will be given intravenously (maximum two dosages per day).

1, 3, 6 months patients will be called to assess neuropathic pain. Neuropathic Pain Symptom Inventory (NPSI) will be used.

• TAP (transversus abdominis plane block) (Procedure): the ultrasound-guided regional block of abdominal wall muscles to treat acute postoperative pain. Stimuplex Ultra 360 needle will be used and 0.375% ropivacaine administered (0.2 mL/kg).
• QL (quadratus lumborum block) (Procedure): the ultrasound-guided regional block of abdominal wall muscles to treat acute pain, similar to transversus abdominis plane block, but with a distribution of local anesthetic towards paravertebral space. Stimuplex Ultra 360 needle will be used and 0.25% bupivacaine administered (0.2 mL/kg).
• Ropivacaine (Drug): In both groups (TAP\&QLB) 0.375% ropivacaine will be given (0.2 mL/kg)
• Needle (Device): Ultrasound-guided, Stimuplex ultra 360 needle will be used in the study
• paracetamol (Drug): Intravenous paracetamol will be used (1.0 gram), up to 4 grams per day
• metamizole (Drug): Intravenous metamizole will be used (1.0 gram), up to 4 grams per day
• Ketoprofen (Drug): Intravenous ketoprofen will be used (0.1 gram), up to 200 milligrams per day
• Morphine (Drug): Intravenous morphine (5 mg) will be given when pain exceeds 40 mm in VAS (maximum 2 doses per day)

Primary outcomes

• Postoperative pain [up to 24 hours after the surgery]: Acute pain measured with VAS (visual-analogue scale). VAS in milimmeters. Minimum value 0, maximum 100. Less better - less severe pain. 0 no pain at all.

Secondary outcomes

• Neuropathic pain [6 months from the surgery]: Neuropathic pain occurrence assessed with Neuropathic Pain Symptom Inventory (NPSI) 10 descriptive variables, each one from 0 to 10. 0 means no pain. 10 very high chance of occurrence of neuropathic pain.

Sex: Female, ages: 18 Years to 70 Years

Inclusion Criteria:

* obtained consent
* singleton pregnancy
* subarachnoid anesthesia

Exclusion Criteria:

* coagulopathy
* allergy to local anesthetics
* depression, antidepressant drugs treatment
* epilepsy
* usage of painkiller before surgery
* addiction to alcohol or recreational drugs

• Mirosław Czuczwar, M.D., PhD, Study chair, Medical University of Lublin