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Whether low thoracic epidural analgesia improves postoperative cesarean pain qualities than conventional lumbar epidural analgesia?
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low thoracic patient controlled epidural analgesia | Experimental |
| |
| Lumbar epidural patient controlled epidural analgesia | Active Comparator |
| |
| Low thoracic epidural morphine | Active Comparator |
| |
| Lumbar epidural morphine | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| low thoracic epidural | Procedure | obstetric epidural catheters inserted at low thoracic intervertebral spaces |
|
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of women with a visual analogue scale> 33 mm | postoperative two days | |
| Pain intensity | pain intensities in three category, namely static, dynamic and uterine cramping, gauged by a 100 mm visual analogue scale | postoperative two days |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse effects | Incidences of epidural-related adverse effects including sedation states, sensory blockade, motor blockade, pruritus, nausea and vomiting | postoperative two days |
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Exclusion:
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| Name | Affiliation | Role |
|---|---|---|
| Chun-Yu Wu | National Taiwan University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Taiwan University Hospital | Taipei | Taiwan |
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| lumbar epidural | Procedure | obstetric epidural catheters inserted at low thoracic intervertebral spaces (conventional) |
|