Perioperative Care and Operating Room Management最新文献

{"title":"Ultrasound guided ilioinguinal, iliohypogastric nerve block, transversus abdominis plane block and quadratus lumborum block for scheduled cesarean delivery: A randomized clinical trial","authors":"Mona Mohamed Mogahed ,&nbsp;Jehan Mahmed Ezzat Darweesh ,&nbsp;Mohamed Shafik Elkahwagy ,&nbsp;Omar Mhd Mounir Brnieh ,&nbsp;Faris Mohammed Shafik Moharan ,&nbsp;Wael Shebl Hassan Easa","doi":"10.1016/j.pcorm.2025.100561","DOIUrl":"10.1016/j.pcorm.2025.100561","url":null,"abstract":"<div><h3>Background</h3><div>Optimal postoperative pain management is essential for enhancing recovery outcomes after cesarean delivery (CD). Regional anesthesia techniques, including ilioinguinal and iliohypogastric (II/IH) nerve blocks, transversus abdominis plane (TAP) block, and quadratus lumborum (QL) block, have gained recognition for their ability to provide effective analgesia while reducing reliance on systemic medications. These approaches are considered both safe and effective, particularly when performed under ultrasound (US) guidance. This study aims to evaluate and compare the efficacy of US-guided II/IH nerve block, TAP block, and QL block in postoperative pain management following elective CD.</div></div><div><h3>Methods</h3><div>A total of 150 patients aged 18- 45 years old undergoing elective CD were randomly assigned to receive one of the three US-guided nerve block techniques. Patients were allocated at random in three groups by sealed envelopes. A mixture of (0.5 % ropivacaine mixed with adrenaline 2 µ/mL) was injected after the completion of surgery under spinal anesthesia. The primary outcome was the duration of analgesia in hours. The secondary outcomes included pain scores assessment using the Numeric Rating Scale (NRS) at multiple time points postoperatively, opioid consumption, time to first analgesic request, and any complications related to the nerve blocks.</div></div><div><h3>Results</h3><div>Patients who received QL block reported significantly the longest duration of analgesia (36 h) compared to those who received II/IH block (22.4±9.6 h) with P value &lt;0.001 (95 % CI), or those who received TAP block (28.36±7.7 h) with P value &lt;0.001 (95 % CI). The QL group shows also the lowest NRS scores during the first 24 with no need for morphine compared to those in the other two groups who consumed (0.15±0.07 mg) and (0.068±0.07 mg) in II/IH group and TAP group respectively with P value &lt;0.001(95 % CI).</div></div><div><h3>Conclusion</h3><div>The QL block offered strong and long-lasting pain relief, eliminating the need for opioids during the first 24 h after CD. The TAP block provided early analgesia but required additional pain control after 12 h. In comparison, the II/IH nerve blocks were effective for a shorter duration, with rescue analgesia needed as early as 6 h postoperatively.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100561"},"PeriodicalIF":1.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of gastric ultrasound to identify GLP-1RA users at high risk of aspiration during surgery","authors":"Alessandra T. Ayers ,&nbsp;Cindy N. Ho ,&nbsp;Nicole Y. Xu ,&nbsp;Sergio D. Bergese ,&nbsp;Ana Costa ,&nbsp;David Kerr ,&nbsp;David C. Klonoff","doi":"10.1016/j.pcorm.2025.100562","DOIUrl":"10.1016/j.pcorm.2025.100562","url":null,"abstract":"<div><div>The use of Glucagon Like Peptide-1 Receptor Agonists (GLP-1RAs) has been associated with delayed gastric emptying, which may result in patients scheduled for elective procedures presenting with increased gastric contents in the preoperative stage. Patients with shorter fasting periods, or increased gastric volume, present a concern for the anesthesiologist because of the danger of pulmonary aspiration, which carries a high risk of morbidity and mortality. The use of preoperative point of care (POC) gastric ultrasound (GUS) would be expected to identify patients with increased gastric contents thus requiring postponement or specific anesthetic management practices by an anesthesiologist in the perioperative setting. This article presents reasons for recommending 1) routine GUS for patients at risk to assess for increased gastric contents before elective surgical or endoscopic procedures and 2) specific anesthesia management practices when increased gastric contents are identified.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100562"},"PeriodicalIF":1.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the relationship between knowledge, attitude, and practice toward hepatitis C virus among medical waste handlers in Sidama, Ethiopia: A structural equation modeling approach","authors":"Birhanu Betela Warssamo","doi":"10.1016/j.pcorm.2025.100558","DOIUrl":"10.1016/j.pcorm.2025.100558","url":null,"abstract":"<div><h3>Background</h3><div>Medical waste handlers are highly exposed to hepatitis C virus. Assessing their knowledge, attitude, and practice is essential for prevention. This study examined their knowledge, attitude, and practice toward HCV using structural equation modeling.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted among 282 medical waste handlers in Sidama region, Ethiopia from Oct 2021 – July 2022. Data were collected by structured questionnaire. Reliability and validity were confirmed. Descriptive statistics and structural equation modeling were performed using STATA 14 software.</div></div><div><h3>Results</h3><div>The study showed 55.1 %, 95 % CI: (50.23, 60.96) had good knowledge, 63.5 %, 95 % CI: (58.60, 65.70) had favorable attitude and 51.9 %, 95 % CI: (49.40, 55.43) had good practice. Knowledge significantly influenced both attitude and practice, while attitude had a direct effect on practice. Knowledge also exhibited a significant indirect effect (<span><math><mover><mi>β</mi><mo>^</mo></mover></math></span>= 0.11, 95 % CI= (0.008, 0.212), p = 0.035) and a total effect (<span><math><mover><mi>β</mi><mo>^</mo></mover></math></span>= 0.50, 95 % CI= (0.198, 0.802), p = 0.002) on practice through attitude. Additionally, frequency of reading newspapers, watching TV, listening to the radio, internet usage, years of experience, age, and monthly income had significant indirect and total effects on attitude through knowledge. Similarly, these variables, along with household size, had significant indirect and total effects on practice through knowledge.</div></div><div><h3>Conclusion</h3><div>Knowledge is critical to improving both attitudes and practices toward HCV prevention. Training programs, media campaigns, and socioeconomic improvements are recommended.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100558"},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operationalising the right to refuse treatment: karnataka’s 2025 response to the 2023 Order","authors":"Uzodinma Yurriens Ezenduka,&nbsp;Debarati Halder","doi":"10.1016/j.pcorm.2025.100557","DOIUrl":"10.1016/j.pcorm.2025.100557","url":null,"abstract":"<div><h3>Background</h3><div>Indian law recognises refusal of life-sustaining treatment and accepts advance directives. The order of 24 January 2023 sets attestation before a notary or a Gazetted Officer, allows authenticity checks through digital health records or named public custodians, and assigns activation to Primary and Secondary Medical Boards. This study asks whether Karnataka’s 2025 measures supply the required custody route and how hospitals can record cross-district verification within existing law.</div></div><div><h3>Methods</h3><div>Doctrinal analysis of national rules and Karnataka’s 2025 instruments; review of professional guidance on end-of-life decisions and Do-Not-Attempt-Resuscitation (DNAR); and use of migration data to frame document reach. From these sources, a concise verification workflow and audit checks were derived.</div></div><div><h3>Findings</h3><div>Karnataka names the Joint Commissioner in each Bruhat Bengaluru Mahanagara Palike zone and the Executive Officer of each taluk panchayat as custodians, and standardises Secondary Medical Boards from existing practitioner pools, with judicial acknowledgment of compliance. A three-channel method suits high mobility: consented access to a personal health record, contact with persons named in the directive, and written confirmation from the identified custodian. The file then carries an authenticity note recording version, attestation, source, and times, plus time-stamped minutes from both Boards. Treating authenticity as reach and version control improves reliability across districts and yields clear audit points, including time to first verified copy and concordance across versions.</div></div><div><h3>Conclusions</h3><div>Karnataka’s measures answer the custody question in the affirmative and allow verification within the national scheme. With attested directives, named contacts, reachable custodians, DNAR where relevant, and brief reasoned minutes, hospitals can produce a reviewable record that supports timely decisions while respecting autonomy and privacy.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100557"},"PeriodicalIF":1.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of spinal Anaesthesia in traditional sitting position versus cross-legged sitting position in Parturients undergoing elective caesarean section—a Randomised controlled trial","authors":"S. Podder ,&nbsp;I.A. Khan ,&nbsp;L Shenoy ,&nbsp;A. Satish ,&nbsp;M. Kulkarni ,&nbsp;R.R. Krishnabhat ,&nbsp;D. Shetty ,&nbsp;S. Thimmaiah Kanakalakshmi","doi":"10.1016/j.pcorm.2025.100556","DOIUrl":"10.1016/j.pcorm.2025.100556","url":null,"abstract":"<div><h3>Background</h3><div>Spinal anaesthesia is the preferred technique for caesarean delivery, owing to the several benefits it carries for mother and fetus. Appropriate patient positioning is vital as it improves the patient comfort, reduces the time taken, the number of attempts required, and decreases the number of needle and bone contacts during the procedure. Our study primarily aimed to compare number of attempts taken for successful needle placement in a sitting position versus a cross-legged sitting position. Secondary objectives included patient comfort, ease of palpation, and block characteristics.</div></div><div><h3>Methods</h3><div>Our study was a prospective, nonblinded, single-centre study. The patients were randomly assigned to one of the two groups using a computer-generated randomisation table and opaque envelope technique. A total of 110 parturients posted for the elective caesarean delivery received spinal anaesthesia in either a traditional sitting position or a cross-legged sitting position.</div></div><div><h3>Results</h3><div>The parturients in both groups were comparable in terms of age, height and weight. The number of attempts was equal in both groups, with 60 % of patients were successful at 1st attempt; <em>n</em> = 33 <em>p-</em>Value = 0.384). The landmark palpability, block characteristics and patient comfort were comparable in both groups</div></div><div><h3>Conclusion</h3><div>We found comparable results in both positions, either traditional sitting position can be used to administer spinal anaesthesia in parturients based on their comfort and preference</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100556"},"PeriodicalIF":1.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of intrathecal morphine and posterior quadratus lumborum block for post-caesarean analgesia","authors":"Ahmed Omar Mahmoud ,&nbsp;Gamal Mohamed Abu Dahab Ibrahim ,&nbsp;Mahmoud Alhasan Mohamed Hasan ,&nbsp;Waleed Ahmad Ali Hussein Atteia ,&nbsp;Ahmed Abdelkader Ahmed ,&nbsp;Mostafa Hassanien Hassanien Bakr","doi":"10.1016/j.pcorm.2025.100559","DOIUrl":"10.1016/j.pcorm.2025.100559","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management after caesarean delivery is essential to promote maternal recovery, facilitate early mobility, and support mother-infant bonding. Traditionally, intrathecal morphine (ITM) has been widely used due to its strong analgesic effects, but concerns about opioid-related side effects have led to growing interest in alternative regional techniques such as the quadratus lumborum block (QLB). Comparative evidence on the efficacy of these approaches in obstetric patients remains limited.</div></div><div><h3>Methods</h3><div>In a randomized trial, 70 cesarean patients underwent spinal anesthetic at Assiut University Hospital. The study compared bilateral posterior QLB with 0.25 % bupivacaine to 100 μg ITM. Secondary outcomes included pain scores, time to first morphine request, side effects, quality of recovery, and functional outcomes; the primary outcome was 24-hour IV morphine consumption.</div></div><div><h3>Results</h3><div>Morphine consumption over 24 h was similar between the ITM and QLB groups, averaging 6.4 mg and 8.5 mg, respectively. Pain levels at rest and during movement did not differ significantly between the two groups at any time point. However, a subgroup analysis showed that QLB patients with a BMI of 30 kg/m² or higher required more morphine and reported higher peak pain scores compared to those in the ITM group (10.5 mg vs 7.4 mg, <em>p</em> &lt; 0.05). No such difference was seen in patients with a BMI below 30 kg/m². In a multivariate analysis, BMI emerged as the only significant predictor of 24-hour morphine consumption (<em>p</em> = 0.016).</div></div><div><h3>Conclusion</h3><div>ITM and posterior QLB provide comparable postoperative analgesia after cesarean delivery for the general population. However, patient factors such as BMI and age may influence postoperative opioid requirements and should be considered when selecting an analgesic technique to optimize recovery and minimize side effects.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100559"},"PeriodicalIF":1.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a clinical competency evaluation index for operating room nurses in the Italian context: Delphi method and analytic hierarchy process","authors":"Gabriele Caggianelli ,&nbsp;Irene Dello Iacono ,&nbsp;Rita Patrizia Tomasin ,&nbsp;Pamela Pellini ,&nbsp;Luana Di Marte ,&nbsp;Eleonora Bruno ,&nbsp;Claudia Angelucci ,&nbsp;Paolo Mazzuca ,&nbsp;Fabio Petrelli ,&nbsp;Sara Morales Palomares ,&nbsp;Giovanni Cangelosi ,&nbsp;Stefano Mancin","doi":"10.1016/j.pcorm.2025.100554","DOIUrl":"10.1016/j.pcorm.2025.100554","url":null,"abstract":"<div><h3>Purpose</h3><div>To achieve consensus on essential elements of a clinical competency assessment for operating room nurses (OR) in Italy</div></div><div><h3>Design</h3><div>Delphi study</div></div><div><h3>Methods</h3><div>Between October 2023 and September 2024, 24 experts, including OR nurses, coordinators, and managers, identified key elements. Data collection involved two Delphi rounds and the analytic hierarchy process. Consensus was reached with a mean score ≥ 3.5 or variance &lt; 20 %.</div></div><div><h3>Findings</h3><div>Five key dimensions were identified: Professional, Ethical, and Legal Practice; Nursing Care &amp; Perioperative Practice; Interpersonal Relationships &amp; Communication; Organizational, Managerial &amp; Leadership Skills; and Education, Research &amp; Professional Development. The framework, with 66 competency elements, highlights the central role of nursing care and perioperative practice.</div></div><div><h3>Conclusions</h3><div>This framework highlights the multifaceted nature of perioperative nursing, with the Nursing Care &amp; Perioperative Practice dimension being central. It also emphasizes the importance of non-technical competencies, such as communication, leadership, and professional development, in improving patient outcomes and teamwork.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100554"},"PeriodicalIF":1.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and staff safety differences between open and laparoscopic surgical procedures: A qualitative study of operating room nurses' perspectives","authors":"Neslihan Ilkaz ,&nbsp;Dercan Gencbas","doi":"10.1016/j.pcorm.2025.100555","DOIUrl":"10.1016/j.pcorm.2025.100555","url":null,"abstract":"<div><h3>Background</h3><div>Operating room nurses play a critical role in maintaining safety for both patients and staff during the perioperative period. Given the distinct nature of open and laparoscopic surgical procedures, they must identify and address procedure-specific safety risks through preventive strategies.</div></div><div><h3>Aim</h3><div>This study aimed to investigate the factors that threaten patient and staff safety in open and laparoscopic surgeries.</div></div><div><h3>Methods</h3><div>Data were collected through semi-structured interviews with 18 operating room nurses from various surgical units selected via purposive sampling. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.</div></div><div><h3>Results</h3><div>Analysis yielded three main themes: Operating room environment, Staff responsibility,and Risk specific for surgical procedure. Sub-themes included environmental and psychological factors, team harmony, risk in surgical preparation, and risk during intraoperative. The findings showed that open and laparoscopic surgical procedures posed different risks to patient and staff safety.</div></div><div><h3>Conclusions</h3><div>Recognizing the safety challenges of different surgical methods is essential for improving outcomes. Operating room nurses and surgical teams should implement proactive, procedure-specific strategies to mitigate risks across all phases of surgery.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100555"},"PeriodicalIF":1.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communication challenges faced by operating room students in clinical environments: Insights from a qualitative content analysis","authors":"Fatemeh Davodabadi ,&nbsp;Amirali Alizadeh ,&nbsp;Fatemeh Samiee ,&nbsp;Behzad Imani","doi":"10.1016/j.pcorm.2025.100553","DOIUrl":"10.1016/j.pcorm.2025.100553","url":null,"abstract":"<div><h3>Background</h3><div>Effective communication is a crucial non-technical skill in high-pressure clinical environments like operating rooms, impacting patient safety and team coordination. However, operating room students face obstacles in developing these skills during clinical training. This study aimed to explore and provide an in-depth understanding of the contextual and system-level factors shaping communication barriers encountered by operating room students in clinical settings.</div></div><div><h3>Methods</h3><div>A qualitative study with a conventional content analysis approach was conducted in 2025 among ten undergraduate operating room students from Hamadan University of Medical Sciences, western Iran. Participants were selected through purposive sampling, and recruitment continued until data saturation was achieved. Data were collected through semi-structured interviews and analyzed concurrently using the Graneheim and Lundman method. Trustworthiness was ensured using Guba and Lincoln’s criteria.</div></div><div><h3>Results</h3><div>The analysis identified five main themes:(1) <em>Intrapersonal barriers</em> (fear of mistakes, low self-esteem, introversion, lack of interest in the clinical environment),(2) <em>Restrictive organizational and hierarchical structures</em> (surgeons’ authoritarianism, hierarchical culture, lack of formal communication channels),(3) <em>Gap between academic training and clinical demands</em> (insufficient communication skills training, exclusive focus on technical skills, lack of structured feedback),(4) <em>Clinical environmental pressures</em> (heavy workload, time constraints, adverse physical and psychological conditions), and (5) <em>Lack of professional support</em> (absence of active clinical instructors, neglect of students’ roles by the healthcare team, scarcity of positive communication role models).</div></div><div><h3>Conclusion</h3><div>Communication barriers among operating room students are multifaceted, shaped by individual, organizational, educational, and environmental factors. Addressing these challenges requires curriculum revisions, strengthened professional support, and fostering psychologically safe clinical environments.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100553"},"PeriodicalIF":1.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analgesic efficacy of erector spinae block, quadratus lumborum block, and intrathecal morphine for post-operative pain relief after cesarean section: A randomized study","authors":"Ghada Mohammad AboElfadl ,&nbsp;Obey Mohamed Shaker ,&nbsp;Ismail Elsaid Eldeeb ,&nbsp;Mahmoud Mamdouh Ekram ,&nbsp;Ahmad Mohamed Aboelfadl","doi":"10.1016/j.pcorm.2025.100552","DOIUrl":"10.1016/j.pcorm.2025.100552","url":null,"abstract":"<div><h3>Background</h3><div>Optimal post-cesarean analgesia remains challenging. We compared the efficacy of erector spinae plane block (ESB), quadratus lumborum block (QL), and intrathecal morphine (ITM) in a randomized trial.</div></div><div><h3>Methods</h3><div>Patients undergoing cesarean delivery under spinal anesthesia were randomized to three groups 40 patients each. ITM group (hyperbaric bupivacaine + 150 µg morphine), QL group (ITM + bilateral QL block with 0.25 % bupivacaine + dexamethasone), ESB group (ITM + bilateral ESB block with 0.25 % bupivacaine + dexamethasone). The primary outcome was the time to first rescue analgesia. Secondary outcomes included pain scores (NRS at rest and on movement), the amount of analgesics consumption during the first 24 h following surgery, changes in hemodynamics, side effects, and patient satisfaction.</div></div><div><h3>Results</h3><div>QLB group provided a significantly longer time to the first analgesic request compared to both ESB and ITM (17.53 ± 1.92 h, 12.63 ± 1.19 h, 8.43 ± 1.13 h respectively), with <em>p</em> &lt; 0.001. QLB group also resulted in a significantly lower number of analgesic doses compared to ITM and ESB groups. Numeric Rating Scale (NRS)pain scores at rest &amp; on movement was significantly lower in the QLB and ESB group at various times compared to ITM. Patient satisfaction was highest in the QLB group.</div></div><div><h3>Conclusion</h3><div>QL and ESB blocks are superior to ITM alone, with QL potentially offering better visceral analgesia.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100552"},"PeriodicalIF":1.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}