The Effect Between Transverse Abdominis Plane Block And Quadratus Lumborum Block On Endorphin Beta Levels And Pain Scales In Post Cesarean Section Patients

Rudyanto Wiharjo Seger, Christrijogo Sumartono, Puspa Wardhani, Aditiawarman Aditiawarman

Abstract


Background: Cesarean section is a surgical procedure that is often performed in labor and causes moderate to severe pain for 48 hours postoperatively. The provision of local anesthesia drugs post-cesarean section can be given by the Transverse Abdominis Plane (TAP) block and Quadratus Lumborum (QL) block. This study was to determine the effect of analgesia between the Transverse Abdominis Plane block and Quadratus Lumborum block on the scale of post-cesarean section pain and level of the beta-endorphin post-operative cesarean section under spinal anesthesia. Methods: An experimental randomized controlled clinical trial study was conducted on 30 pregnant women aged 18-45 years post-cesarean section who were treated electively with ASA I - II and anesthesia under spinal anesthesia. Patients who met the inclusion criteria were treated by dividing three groups randomly through the computer. In group A, control and Transverse Abdominis Plane Block are given; group B, given control and Quadratus Lumborum Block; and group C, given control (ketorolac and tramadol). Furthermore, it was recorded and measured the level of beta-endorphin, and the Wong Baker Faces Scale (WBFS) pain scale postoperatively and 6 hours postoperatively. Data collected then analyzed by SPSS’s computer program. Results: The effect of QL block administration helps relieve the WBFS pain scale by five times and decreases beta-endorphin level by 0.2 times compared to TAP block administration. The effect of QL block administration helped relieve the WBFS pain scale by 13.5 times and decreased beta-endorphin level by 5.4 times compared to standard therapy. The effect of TAP block administration helps to reduce the WBFS pain scale by 7.4 times and to reduce beta-endorphin level by 5.1 times compared to standard therapy. Conclusion: QL block relieves the WBFS pain scale and decreases the beta-endorphin level better than the TAP block. Keywords: Cesarean section, post-operative pain, beta-endorphin, Quadratus Lumborum block, Transversus Abdominis Plane block

Save to Mendeley


Keywords


Cesarean section; post-operative pain; beta-endorphin; Quadratus Lumborum block; Transversus Abdominis Plane block

Full Text:

PDF

References


Kendrisic M., Petakovic S. Obstetric Anesthesia: Post Operative analgetic After Caesarean Section - The Simpler, The Better!. Fifth Annual Spring Scientific Symposium In Anaesthesiology and Intensive care. Faculty of Medicine, NIS. 2013;130- 133.

Borges, N. de C., Pereira, L.V., Moura, L.A. de, Silva, T.C., Pedroso, C.F. Predictors for Moderate to Severe Acute Postoperative Pain after Cesarean Section. Pain Research and Management. 2016;1–6.

Ituk, U., Habib, A.S. Enhanced recovery after cesarean delivery. F1000Research. 2018;7;513;1-11.

Sprouse-Blum, A.S., Bs, G.S., Sugai, D., Parsa, F.D. Understanding Endorphins and Their Importance in Pain Management. 2010;69;1-10.

Asvadi, N.H., Morgan, M., Herath, H.M., Hewavitharana, A.K., Shaw, P.N., Cabot, P.J. Beta-Endorphin 1–31 Biotransformation and cAMP Modulation in Inflammation. PLoS ONE 9. 2014;9;1-11.

Mcintosh, T.K., Bush, H.L., Palter, M., Hay, J.R., Aun, F., Yeston, N.S., Engdahl, R.H. Prolonged Disruption of Plasma ??-Endorphin Dynamics Following Surgery: Survey of Anesthesiology. 1986;30,32.

Abboud, T.K., Noueihed, R., Khoo, S., Hoffman, D.I., Varakian, L., Henriksen, E., Goebelsmann, U. Effects of induction of general and regional anesthesia for cesarean section on maternal plasma β-endorphin levels. American Journal of Obstetrics and Gynecology. 1983;146;927–930.

Goebelsmann, U., Abboud, T.K., Hoffman, D.I., Hung, T.T. Beta-endorphin in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1984;17;77–89.

Matejec, R., Ruwoldt, R. Release of Beta-Endorphin Immunoreactive Material Under Perioperative Conditions into Blood or Cerebrospinal Fluid: Significance for Post-operative Pain?. fANESTH ANALG 6. 2003;96(2):481-6.

Bernstein, L., Garzone, P.D., Rudy, T., Kramer, B., Stiff, D., Peitzman, A. Pain Perception and Serum Beta-Endorphin in Trauma Patients. Psychosomatics. 1995;36; 276–284.

Amstrong D., and Straton R.D. Oxidative stress and antioxidant protection: The science of free radical biology and disease. New Jersey: John Wiley and Son. 2016.

Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Blocks [Internet]. NYSORA. 2018 [dikutip 11 Agustus 2019]. https://www.nysora.com/regional-anesthesia-for-specific-surgical- procedures/abdomen/ultrasound-guided-transversus-abdominis-plane-quadratus- lumborum-blocks/

Transversus Abdominis Plane Block: Background, Indications, Contraindications. 20 September 2018 [dikutip 5 Agustus 2019]; https://emedicine.medscape.com/article/2000944-overview#a1

Karmakar M.K., Coyne J., Donnell J.G. Musculoskeletal Ultrasound for Regional Anaesthesia and Pain Medicine 2nd Edition. Department of Anaesthesia and Intensive Care The Chinese University of Hong Kong. 2016;385-93.

Blanco, R., Ansari, T., Riad, W., Shetty, N. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016;41;757–762.

Kumar, G.D., Gnanasekar, N., Kurhekar, P., Prasad, T.K. A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries: A Prospective Double-blinded Study. Anesth Essays Res. 2018;12;919–923.

Mieszkowski, M.M., Mayzner-Zawadzka, E., Tuyakov, B., Mieszkowska, M., Żukowski, M., Waśniewski, T., Onichimowski, D. Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study. Ginekologia Polska. 2018;89;1-8.

Kendrisic M., Petakovic S. Obstetric Anesthesia: Post Operative analgetic After Caesarean Section - The Simpler, The Better!. Fifth Annual Spring Scientific Symposium In Anaesthesiology and Intensive care. Faculty of Medicine, NIS. 2013;130- 133.

Borges, N. de C., Pereira, L.V., Moura, L.A. de, Silva, T.C., Pedroso, C.F. Predictors for Moderate to Severe Acute Postoperative Pain after Cesarean Section. Pain Research and Management. 2016;1–6.

Ituk, U., Habib, A.S. Enhanced recovery after cesarean delivery. F1000Research. 2018;7;513;1-11.

Sprouse-Blum, A.S., Bs, G.S., Sugai, D., Parsa, F.D. Understanding Endorphins and Their Importance in Pain Management. 2010;69;1-10.

Asvadi, N.H., Morgan, M., Herath, H.M., Hewavitharana, A.K., Shaw, P.N., Cabot, P.J. Beta-Endorphin 1–31 Biotransformation and cAMP Modulation in Inflammation. PLoS ONE 9. 2014;9;1-11.

Mcintosh, T.K., Bush, H.L., Palter, M., Hay, J.R., Aun, F., Yeston, N.S., Engdahl, R.H. Prolonged Disruption of Plasma ??-Endorphin Dynamics Following Surgery: Survey of Anesthesiology. 1986;30,32.

Abboud, T.K., Noueihed, R., Khoo, S., Hoffman, D.I., Varakian, L., Henriksen, E., Goebelsmann, U. Effects of induction of general and regional anesthesia for cesarean section on maternal plasma β-endorphin levels. American Journal of Obstetrics and Gynecology. 1983;146;927–930.

Goebelsmann, U., Abboud, T.K., Hoffman, D.I., Hung, T.T. Beta-endorphin in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1984;17;77–89.

Matejec, R., Ruwoldt, R. Release of Beta-Endorphin Immunoreactive Material Under Perioperative Conditions into Blood or Cerebrospinal Fluid: Significance for Post-operative Pain?. fANESTH ANALG 6. 2003;96(2):481-6.




DOI: https://doi.org/10.33508/jwm.v6i2.2783