Continuous Epidural Analgesia after Cesarean Section; a Comparison of L2-3 Versus T12-L1 Epidural Route

Kim, Dong Yeon; Kim, Jong Hak; Lee, Choon Hi

Abstract

BACKGROUND: A combination of epidural fentanyl and bupivacaine has been used for many years for the management of postoperative pain. The aim of this study was to compare the analgesia and side effects according to the site of epidural puncture on L2-3 or T12-L1 followed by infusion of fentanyl and bupivacaine after cesarean section.
METHODS
Sixty female patients scheduled for cesarean section were assigned randomly to receive fentanyl and bupivacaine via an epidural catheter inserted at L2-3 (group I) or a T12-L1 (group II) for postoperative analgesia. Visual analogue scales (VAS) for pain were recorded at 1, 6, 12, 24 and 48 hr postoperatively and side effects and degree of satisfaction were noted.
RESULTS
Rest pain scores at 1 hr and dynamic pain scores at 6 hr postoperatively in group II were significantly less than in group I. Rest pain scores in group II at 24 hr and 48 hr postoperatively were significantly more than in group I. Leg numbness and weakness occurred significantly less in group II than in group I. The average pain scores using VAS in two groups were less than 3. There were no significant differences in other side effects and degree of satisfaction between the two groups.
CONCLUSIONS
The continuous epidural infusion of fentanyl and bupivacaine provides good postoperative analgesia and high degree of satisfaction after cesarean section. However, leg numbness and weakness occurred significantly less in T12-L1 group than in L2-3 group. We conclude that epidural analgesia performed on T12-L1 is a more advisable method for the cesarean patients in need of early ambulation.