(1)General objective: Comparing the duration of analgesia after posterior and lateral transverse abdominal blocks under ultrasound guidance after cesarean section.
(2)Design: No placebo-controlled, one center, randomized, double blind late stage clinical trial (a) all women 18 to 50 years who were referred for elective or emergency cesarean section to general operating room of Rasoul Akram Hospital, Sample size: 76, intervension period:2015-2016.
(3)Setting, conduct and Intervention: For all patients undergoing elective cesarean section after spinal anesthesia and analgesia, Monitoring (pulse oximetry, non-invasive measurement of blood pressure and electrocardiogram), and IV line and 500 ml ringer therapy were performed. Spinal anesthesia was done in the sitting position and in sterile conditions with a needle (25 dr japan) and 10 mg of bupivacaine (maylan made in france) for all patients in the operating room. After reaching the T4 level of anesthesia, cesarean section was begun.
When systolic blood pressure decreased to less than 80 mm Hg or the drop was more than 30%, 10 mg of ephedrine was injected and in the case of heart rate drop to less than 50 beats per minute, atropine 0.5 mg was injected. After the cesarean and in the recovery room, patients randomly divided into two groups and all patients were monitored (pulse oximetry, non-invasive measurement of blood pressure and electrocardiogram). When the level of spinal anesthesia decreased 2 to 3 levels compared to T4 (The assessment by pin prink and cotton alcohol on the anterior abdomen), 15 cc of bupivacaine 0.25% (Bupivacaine maylan made in france) using a 23 gauge spinal needle (dr japan) was injected in the SUPINE position under the guidance of linear ultrasound probe (Mark SonoSite made in USA) In sterile conditions.
In one group lateral TAP block has been done on the midaxillary line in the border of coastal margine and iliac crest between internal oblique and transverse abdominis the local anaesthetic bilaterally. The other group went under the posterior Tap block (quaderotus lombrum) in the triangular space of petit (the inferior margin of iliac crest and the posterior border of the latissimus dorsi muscle and anterior border external oblique muscle).
(4)Participants including major eligibility criteria: Patients were divided to two groups. each group were consist of 38 patients.
Inclusion criteria: patients 18 to 50 years old undergoing spinal anesthesia for cesarean section. Exclusion criteria: Patients in the ASA class 3 and more; patients that spinal anesthesia was not successful in them; patients with underlying organic diseases; being allergic to bupivacaine.
(5)Main outcome measures: Pain intensity at rest, Pain intensity in coughing situation, opioid need