L2-3 versus T12-L1 Administration of Meperidine and Bupivacaine Using Patient-Controlled Epidural Analgesia after Obstetric and Gynecologic Surgery / 대한마취과학회지

ABSTRACT

BACKGROUND: A combined administration of epidural opioid and local anesthetic using patient- controlled epidural analgesia (PCEA) produces effective postoperative analgesia, but often causes profound motor and sensory blockade. The purpose of this study is to investigate the effect the location of the catheter insertion site has on total dose requirements and troublesome side effects including motor and sensory blockade after surgery. METHODS: 140 patients who had undergone obstetric and gynecologic surgery were randomly assigned to receive either L2-3 (Group L2-3) or T12-L1 (Group T12-L1) epidural catheter. All patients received meperidine and bupivacaine by PCEA. Patients were assessed with respect to total dose requirements, visual analogue scores and side effects. RESULTS: Total dose requirements, motor and sensory blocks were significantly lower in group T12-L1 compared with group L2-3. There were no significant differences in VAS, pruritus, nausea/vomiting, or patient's satisfaction. CONCLUSIONS: When the epidural placement level is closer to the dermatomes of the surgical incision in lower abdominal surgery, the total dose requirements can be reduced, and motor blocks that interfere with early ambulation and sensory block can also be reduced.