Abstract
Author(s): Ibrahim Shazly Mohamed, Amr Raafat Mahmoud Seif* Jumana Baaj and Ahmed Alizein Elnizamy
Objective. The aim of our study was to evaluate a range of heart rates in the first trimester in twin pregnancy and the influence of the rate of fetal heart on the outcome of the pregnancy. Background and
Objectives: Managing acute post-cesarean pain remains challenging. This retrospective study aimed to compare the analgesic duration, 24-hour analgesic consumption, and postoperative pain trajectories of ultrasound-guided bilateral transmuscular Quadratus Lumborum (QL) blocks versus Transversus Abdominis Plane (TAP) blocks within an institutional multimodal analgesia protocol.
Material and methods. The study included 89 twin pregnan cies between 6 and 11 weeks of pregnancy (78 pregnancies finished with good outcome and 11 with unfavorable outco me). Materials and Methods: This retrospective cohort study was conducted at King Saud University Medical City, Saudi Arabia, over a 1-year period (January 1 to December 31, 2023). Eighty adult parturients undergoing elective lower segment cesarean section under spinal anesthesia were analyzed (n = 40 in the QL block group; n = 40 in the TAP block group). Both cohorts received bilateral fascial plane blocks utilizing 15–20 mL of 0.25% bupivacaine per side. Results. The date shows that the heart rate of embryos / fetuses in the first trimester of an uncomplicated twin pregnancy progressively increases between 6 and 8 weeks of pregnancy and then slows down in week 11. Our data shows that the rate of fetal death in the first trimester of twin pregnancy increases progressively with decreasing of the heart rate. In our study none of the twins survived when the observed rate of the fetal heart was less than 110 beats per minute and half of them died when heart rate was between 110 and 120 beats per min. Furthermore, the significant difference in the heart rates of a set of twins was connected with a poor prognosis. In mono chorionic pregnancies with a significant difference in heart rate (20 beats/min or more) despite a normal fetal heart rate (120 beats/min or more) TTTS syndrome was confirmed later in pregnancy.
Results: The primary outcome, mean time to first rescue analgesia, was significantly prolonged in the QL cohort compared to the TAP cohort (21.49 ± 2.05 hours vs. 13.01 ± 1.43 hours; p < 0.001). Total 24-hour paracetamol consumption was significantly lower in the QL group (4.36 ± 0.54 g) than the TAP group (9.98 ± 0.82 g; p < 0.001). Dynamic pain scores (VAS) during functional movement were significantly lower in the QL group across all postoperative intervals from 2 to 48 hours (p < 0.001). Complication rates and hemodynamic profiles were statistically indistinguishable between groups (p > 0.05). Conclusion: The ultrasound-guided trans muscular QL block offers significantly longer analgesic duration, superior control of dynamic movement pain, and lower 24-hour non-opioid analgesic requirements than the TAP block after cesarean sections, maintaining an excellent safety profile.
Conclusions. The ultrasound-guided trans muscular QL block offers significantly longer analgesic duration, superior control of dynamic movement pain, and lower 24-hour non-opioid analgesic requirements than the TAP block after cesarean sections, maintaining an excellent safety profile. Conclusions. The heart rate in twin pregnancy more than 120 beats per minute is connected with a good prognosis, whe reas below 110 beats per minute with a poor prognosis. Furthermore, t