The study will compare the difference between the patient's satisfaction after Erector spinae plane block (ESP) and Quadratus Lumborum block lateral approach after caesarean section alone or as part of multimodal analgesia.
The primary outcome is to test whether the type of plane block has an implication on the patients' satisfaction.
The secondary outcome is to test the difference between the two approaches on the hospital discharge
Parturient female
Scheduled for elective cesarean section
Known allergy to any of the medications used
Patients refused to participate in the study
Patients with emergency section,
Patients with Bleeding disease
Parallel
Bilateral Ultrasound-Guided Erector Spinae Plane Block (group E)
Procedure/SurgeryThe curvilinear ultrasound transducer should be placed in a cephalocaudal orientation over the midline of the back at the desired level. The probe should then slowly be moved laterally until the transverse process is visible. The transverse process requires differentiation from the rib at that level. The transverse process will be more superficial and wider, while the rib will be deeper and thinner. Upon verification of the transverse process, the trapezius muscle, rhomboid major muscle (if performing at T5 level or higher), and erector spinae muscle should be identified superficial to the transverse process. The Tuohy needle should be inserted superior to the ultrasound probe using an in-plane approach in the cephalad to caudal direction.
Bilateral Ultrasound-guided Quadratus Lumborum, Lateral approach (group Q)
Procedure/SurgeryWith the patient positioned in the lateral position, scanning is usually started at the mid-axillary line between the iliac crest and subcostal margin, moving the probe posteriorly until tapering of the three abdominal muscle layers and appearance of fascia transversalis and QL muscle are observed. The fascia transversalis usually appears as a hyperechoic layer, which forms a safe landmark to separate the muscle layers from the peri-nephric fat and the abdominal contents
To test whether the type of the plane block have an implication on the patients' satisfaction.
The patient's satisfaction with the block will be measured using a 4-point Likert assessment to the question, "Are you satisfied with the pain management done after the cesarean section?" totally disagree, disagree, agree, totally agree.
to test the difference between the two approaches on the hospital discharge
report the time for discharge from the hospital after the surgery and if there is any delay or complications after the procedure
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Wael Sayed El Gharabawy
Lead sponsor
Ain Shams University
Sponsor institution
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