Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Preoperative Evaluation
2.2. Epidural Catheterization and Spinal Anesthesia
2.3. Primary Outcome: Pain Intensity Assessment
2.4. Rescue and Adjuvant Analgesics
2.5. Secondary Outcome: Adverse Effects of Epidural Analgesia
2.6. Statistical Analysis
3. Results
3.1. Intraoperative Profiles
3.2. Postcesarean Pain: Proportion of Participants with a VAS Score of >33 mm
3.3. Postcesarean Pain: Comparison of VAS Scores
3.4. Adverse Effect Profiles
3.5. Analgesic Requirement
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Clinical Trial Registration
Acknowledgments
Conflicts of Interest
References
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Low Thoracic PCEA | Lumbar PCEA | Low Thoracic Morphine | Lumbar Morphine | p Value | |
---|---|---|---|---|---|
(n = 45) | (n = 49) | (n = 49) | (n = 46) | ||
Age (yr) | 36.1 ± 4.5 | 35.0 ± 4.5 | 36.4 ± 4.2 | 36.7 ± 4.2 | p = 0.225 |
Height (cm) | 159.3 ± 6.1 | 159.1 ± 5.1 | 161.3 ± 5.5 | 159.5 ± 5.6 | p = 0.204 |
Weight (kg) | 69.5 ± 11.1 | 67.6 ± 10.3 | 71.9 ± 11.0 | 69.8 ± 10.4 | p = 0.285 |
Nulliparous (n; %) | 27 (60.0%) | 27 (55.1%) | 32 (65.3%) | 27 (58.7%) | p = 0.779 |
Indication (n; %) | p = 0.585 | ||||
Previous uterine surgery | 14 (31.1%) | 22 (44.9%) | 19 (38.8%) | 17 (37.0%) | |
Twin | 14 (31.1%) | 6 (12.2%) | 6 (12.2%) | 5 (10.9%) | |
Breech | 5 (11.1%) | 8 (16.3%) | 11 (22.5%) | 9 (19.6%) | |
Fetal abnormality | 4 (8.9%) | 4 (8.2%) | 3 (6.1%) | 3 (6.5%) | |
Maternal request | 3 (6.7%) | 4 (8.2%) | 3 (6.1%) | 3 (6.5%) | |
Other | 5 (11.1%) | 5 (10.2%) | 7 (14.3%) | 9 (19.5%) | |
Preoperative questionnaire | p = 0.342 | ||||
Preoperative anxiety (0–100) | 54 ± 27 | 62 ± 24 | 55 ± 25 | 56 ± 26 | |
Anticipated pain (0–100) | 70 ± 20 | 76 ± 17 | 66 ± 19 | 68 ± 22 | p = 0.081 |
Anticipated medication (0–5) | 4 (3–4) | 4 (3–4) | 3 (3–4) | 4 (3–4) | p = 0.208 |
Low Thoracic PCEA | Lumbar PCEA | Low Thoracic Morphine | Lumbar Morphine | p Value | |
---|---|---|---|---|---|
(n = 45) | (n = 49) | (n = 49) | (n = 46) | ||
Surgical profile | |||||
Operation time (min) | 50.0 ± 14.4 | 50.7 ± 12.2 | 49.4 ± 14.2 | 50.0 ± 12.2 | p = 0.977 |
Blood loss (mL) | 422 ± 173 | 437 ± 170 | 431 ± 119 | 414 ± 89 | p= 0.878 |
Epidural profile | |||||
Skin-epidural depth (cm) | 4.8 ± 0.6 | 4.8 ± 0.7 | 4.8 ± 0.8 | 4.9 ± 0.8 | p = 0.755 |
Procedure time (sec) | 313 ± 309 | 299 ± 255 | 272 ± 203 | 309 ± 341 | p = 0.891 |
Redirection (n) | 1.4 ± 1.3 | 2.0 ± 3.7 | 1.6 ± 1.6 | 1.9 ± 1.8 | p = 0.488 |
Anesthesia profile | |||||
SA level (n; %) | p = 0.054 | ||||
T6 or above | 45 (100%) | 46 (93.9%) | 49 (100%) | 42 (91.3%) | |
Below T6 | 0 (0%) | 3 (6.1%) | 0 (0%) | 4 (8.7%) | p = 0.676 |
Intravenous fluid (mL) | 1009 ± 345 | 1029 ± 281 | 966 ± 295 | 963 ± 338 | |
Norepinephrine (mcg) | 25 ± 21 | 25 ± 21 | 24 ± 25 | 28 ± 33 | p = 0.895 |
Low Thoracic PCEA | Lumbar PCEA | Low Thoracic Morphine | Lumbar Morphine | p Value | |
---|---|---|---|---|---|
(n = 45) | (n = 49) | (n = 49) | (n = 46) | ||
Worst Bromage score (n; %) | p = 0.005 | ||||
0 | 41 (91.1%) # | 34 (69.4%) * | 43 (87.7%) # | 42 (91.3%) # | |
1 | 4 (8.9%) | 9 (18.4%) | 4 (8.2%) | 3 (6.5%) | |
2 | 0 (0%) | 5 (10.2%) | 2 (4.1%) | 1 (2.2%) | |
3 | 0 (0%) | 1 (2.0%) | 0 (0%) | 0 (0%) | |
Pruritus (n; %) | p = 0.099 | ||||
Mild or none | 32 (71.1%) | 40 (81.6%) | 36 (73.5%) | 33 (71.7%) | |
Moderate | 12 (26.7%) | 9 (18.4%) | 13 (26.5%) | 9 (19.6%) | |
Severe | 1 (2.2%) | 0 (0%) | 0 (0%) | 4 (8.7%) | |
PONV (n; %) | p = 0.221 | ||||
None | 40 (88.9%) | 40 (81.6%) | 37 (75.5%) | 38 (82.6%) | |
Nausea | 2 (4.4%) | 8 (16.3%) | 4 (8.2%) | 4 (8.7%) | |
Retch | 0 (0%) | 0 (0%) | 1 (2.0%) | 0 (0%) | |
Vomiting | 3 (6.7%) | 1 (2.1%) | 7 (14.3%) | 4 (8.7%) | |
Ramsay Sedation Scale ≠ 2 | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | p = 0966 |
First passage of flatulence (hr) | 17.3 ± 7.5 | 20.8 ± 8.4 | 26.2 ± 7.9 *# | 25.1 ± 7.6 *# | p < 0.001 |
Recovery numeric rating scale (0–100) | 76.2 ± 10.1 # | 70.8 ± 7.4 * | 76.9 ± 8.7 # | 78.3 ± 8.6 # | p < 0.001 |
Low Thoracic PCEA | Lumbar PCEA | Low Thoracic Morphine | Lumbar Morphine | p Value | |
---|---|---|---|---|---|
(n = 45) | (n = 49) | (n = 49) | (n = 46) | ||
PCEA profile | 206 (193–228) | 275 (228–308) | NA | NA | p< 0.001 |
Total dose (mL) | |||||
Demand number | 9 (4–25) | 21 (9–37) | p = 0.007 | ||
Delivery number | 7 (2–18) | 11 (7–25) | p = 0.002 | ||
Demand/delivery ratio | 1.8 ± 1.2 | 1.6 ± 0.9 | p = 0.371 | ||
Total epidural morphine dose (mg) | NA | NA | 10 (10–11.3) | 11 (10–11) | p = 0.686 |
Number of rescue intervention (n) | 1.0 ± 1.1 # | 2.5 ± 1.5 * | 1.6 ± 1.8 # | 1.7 ± 1.7 * | p < 0.001 |
Supplement epidural morphine dose (mg) | 0.1 ± 0.4 | 0.7 ± 0.9 * | 0.9 ± 1.1 * | 0.8 ± 1.0 * | p < 0.001 |
IV analgesic dose | |||||
Nabuphine (mg) | 1.1 ± 3.2 | 2.5 ± 5.2 | 3.0 ± 6.7 | 2.6 ± 7.1 | p = 0.442 |
Tenoxicam (mg) | 18.7 ± 20.2 | 23.7 ± 21.5 | 16.3 ± 19.9 | 21.7 ± 20.1 | p = 0.301 |
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Chen, Y.-H.; Chou, W.-H.; Yie, J.-C.; Teng, H.-C.; Wu, Y.-L.; Wu, C.-Y. Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial. J. Pers. Med. 2021, 11, 1099. https://doi.org/10.3390/jpm11111099
Chen Y-H, Chou W-H, Yie J-C, Teng H-C, Wu Y-L, Wu C-Y. Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial. Journal of Personalized Medicine. 2021; 11(11):1099. https://doi.org/10.3390/jpm11111099
Chicago/Turabian StyleChen, Ying-Hsi, Wei-Han Chou, Jr-Chi Yie, Hsiao-Chun Teng, Yi-Luen Wu, and Chun-Yu Wu. 2021. "Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial" Journal of Personalized Medicine 11, no. 11: 1099. https://doi.org/10.3390/jpm11111099