An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal–epidural anesthesia: a retrospective study

Abstract

Background Epidural anesthesia affects lower extremities, which often prevents early mobilization postoperatively. The incidence of numbness and motor weakness in the lower extremities with respect to epidural catheter placement site in cesarean section (CS) is uncertain. We aimed to investigate the effect of catheter placement site on postoperative lower extremities numbness and motor weakness in patients who received combined spinal–epidural anesthesia (CSEA) for CS including analgesic effects and optimal epidural placement site in CS. Methods We retrospectively included 205 patients who underwent CS with CSEA at the University of Tsukuba Hospital between April 2018 and March 2020, and assessed numbness and motor weakness in the lower extremities. We also examined whether differences in the intervertebral space of epidural catheter placement and epidural effect on the lower extremities are related to analgesic effects. ANOVA and Mann–Whitney U test were used for statistical analysis. Results The incidence of numbness and motor weakness were 67 (33%) and 28 (14%), respectively. All patients with motor weakness had numbness. A more caudal placement was associated with increased incidence of affected lower extremities. There was no significant difference in the analgesic effect depending on the catheter placement site. When the lower extremities were affected, the number of additional analgesics increased (p < 0.001). Patient-controlled epidural analgesia was used for fewer days in patients with motor weakness (p = 0.046). Conclusion In CS, epidural catheter placement at T10–11 or T11–12 interspace is expected to reduce effect on the lower extremities and improve quality of postoperative analgesia.

Analgesia Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Intravenous Analgesia After Cesarean Section: A Double-Blind Controlled Trial

“…At present, the clinical analgesic methods after cesarean section are mainly patient-controlled epidural analgesia (PCEA) and PCIA, supplemented by oral or intramuscular injection of analgesics, which have their own analgesic advantages, but each one still has different limitations [ 17 ]. Studies have shown that PCEA has a good analgesic effect [ 12 ], which can not only increase the enthusiasm for breastfeeding, but also accelerate the recovery of gastrointestinal function [ 18 ]; however, there are some related complications such as lower limb weakness, numbness and urinary retention [ 19 ]. Hence, there is currently a clear downward trend in the amount of post-cesarean analgesia clinically used by PCEA.…”

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

“…Moreover, Meechan and co-authors [42] let know that anesthesia effects of ropivacaine in their study were inferior to those with lidocaine-epinephrine. A fresh clinical research in Japan [43] support the idea that the more cephalad the epidural catheter is placed, the more the quality of analgesia is, but did not find any difference between epidural catheter placement inT10-11 and T11-12 in post-cesarean section for pain relief. The same study considered that the LA injected via lumbar dermatomes for CS may not provide sufficient analgesia in the lower thoracic dermatome.…”

Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial

“…In this study, we observed participants in the low thoracic PCEA group exhibited a Bromage motor scale profile similar to that of participants who received epidural morphine, but more participants in the lumbar PCEA group experienced prolonged lower extremity weakness after spinal anesthesia. Recently, Murata et al reported findings related to a retrospective cohort of 205 parturients who received combined spinal-epidural anesthesia for cesarean delivery; they also discovered that epidural catheter placement at the low thoracic interspace reduced lower extremity weakness [51]. However, high heterogeneity in epidural catheter sites was observed in that study because the epidurals were inserted by performing landmark palpation, which lacks the precision required for definitive localization at the epidural level [17].…”