Comparisons Between Low Thoracic and Lumbar Epidural Analgesia on Postoperative Pain Low Thoracic v.s. Lumbar Epidural for Post-cesarean Pain

National Taiwan University

Status: Completed

Conditions: Post-cesarean Pain Control Quality

Treatments: Procedure: low thoracic epidural; Procedure: lumbar epidural

Study type: Interventional

Funder types: Other

Identifiers

NCT03946982

201902009RINC

Details and patient eligibility

About

Whether low thoracic epidural analgesia improves postoperative cesarean pain qualities than conventional lumbar epidural analgesia?

Full description

Postoperative pain remains the leading cause of concern in women faced with undergoing a cesarean delivery. Inadequate acute pain management is associated with numerous negative effects, including delayed postpartum recovery, interference with mother-child bonding because postoperative pain limits breastfeeding, and a high risk of postpartum depression and persistent pain.

Epidural analgesia (EA) is being increasingly preferred to systemic opioid because of better analgesic effect. Although EA is widely used for cesarean delivery, the effect of the site of epidural catheter insertion on the quality of postoperative pain management remains inadequately investigated. For example, placement of the epidural catheter in the low thoracic intervertebral spaces may be more suitable for catheter-incision-congruent analgesia during caesarean delivery than in the lumbar intervertebral space; however, epidural catheter insertion is conventionally recommended at the lumbar intervertebral space. Therefore, in this study, we aim to investigate the difference in post-cesarean pain control quality between low thoracic EA and lumbar EA.

Enrollment: 189 patients

Sex: Female

Ages: 20 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion:

1. age between 20-yr and 50-yr parturients
2. elective cesarean delivery

Exclusion:

1. contraindicated to regional anesthesia, eg. coagulopathy (INR> 1.5; platelet< 80000...etc)
2. significant co-morbidities, eg. preeclamspia, heart failure with New York Heart Association (NYHA) Classification> class 2
3. allergy to opioids or local anesthetics

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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189 participants in 4 patient groups

Low thoracic patient controlled epidural analgesia

Experimental group

Treatment:

Procedure: low thoracic epidural

Lumbar epidural patient controlled epidural analgesia

Active Comparator group

Treatment:

Procedure: lumbar epidural

Low thoracic epidural morphine

Active Comparator group

Treatment:

Procedure: low thoracic epidural

Lumbar epidural morphine

Active Comparator group

Treatment:

Procedure: lumbar epidural