AI Article Synopsis
- Patient-controlled epidural analgesia (PCEA) using low thoracic placement is more effective in managing postcesarean pain than lumbar methods, as shown in a study of 189 women.
- The low thoracic PCEA group reported significantly lower dynamic pain and better pain scores overall within 24 hours post-surgery compared to groups receiving lumbar PCEA or morphine.
- While similar adverse effects were noted across all groups, the low thoracic PCEA group had fewer issues with prolonged lower extremity blockage and experienced faster gastrointestinal recovery.
Article Abstract
Unlabelled: Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter-incision incongruent for cesarean delivery.
Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated.
Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade ( = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups ( < 0.001).
Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619661 | PMC |
| http://dx.doi.org/10.3390/jpm11111099 | DOI Listing |
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