The effects of epidural catheter location on outcomes in women undergoing gynaecologic surgery with an abdominal incision: A randomised clinical trial

Introduction: Currently, there is no standard location for the placement of epidural catheters in patients undergoing abdominal gynaecologic surgery. Methods: Adult women undergoing elective gynaecologic surgery with abdominal incision were prospectively enrolled in a randomised double-blind controlled trial comparing postoperative outcomes for lumbar epidural analgesia (LEA) versus thoracic epidural analgesia (TEA). Motor function, proprioception, cold sensation, pain, American Pain Society (APS) Patient Outcome Questionnaire (Modified), Brief Fatigue Inventory (BFI) and Quality of Recovery 9 (QOR9) were assessed. Results: A total of 103 patients enrolled with 88 completing the study. There were no significant differences in demographics, pain scores during hospital stay or nausea/vomiting. Motor blockade was less with TEA compared to LEA but was statistically significant only for right knee extension and flexion and straight leg raise. There was a statistically significant decrease in pruritus with LEA. Subgroup analysis by surgical incision demonstrated a statistically significant decrease in pain scores for TEA for vertical incisions extending above the umbilicus only. Pain scores reported by the patients 7 days after surgery were higher both at rest and maximal for TEA. Conclusions: Lower abdominal procedures for gynaecologic surgery do not appear to require TEA for optimal care unless upper abdominal incision is used or catheters will remain in place greater than 24 h.