{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:14:18Z","timestamp":1788351258689,"version":"build-2803163510"},"reference-count":56,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T00:00:00Z","timestamp":1635292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter\u2013incision incongruent for cesarean delivery. Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of &gt;33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated. Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; p &lt; 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade (p = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups (p &lt; 0.001). Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.<\/jats:p>","DOI":"10.3390\/jpm11111099","type":"journal-article","created":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T23:24:42Z","timestamp":1635377082000},"page":"1099","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Influence of Catheter\u2013Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial"],"prefix":"10.3390","volume":"11","author":[{"given":"Ying-Hsi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-3985","authenticated-orcid":false,"given":"Wei-Han","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0594-0854","authenticated-orcid":false,"given":"Jr-Chi","family":"Yie","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiao-Chun","family":"Teng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Luen","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Medical Education, National Taiwan University, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1002\/ejp.619","article-title":"Quality of pain treatment after caesarean section: Results of a multicentre cohort study","volume":"19","author":"Marcus","year":"2015","journal-title":"Eur. J. Pain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1097\/ALN.0000000000001979","article-title":"Using activity trackers to quantify postpartum ambulation: A prospective observational study of ambulation after regional anesthesia and analgesia interventions","volume":"128","author":"Ma","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/ALN.0000000000001789","article-title":"Recovery after nulliparous birth: A detailed analysis of pain analgesia and recovery of function","volume":"127","author":"Komatsu","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jclinane.2014.06.010","article-title":"The impact of breastfeeding on postpartum pain after vaginal and cesarean delivery","volume":"27","author":"Wen","year":"2015","journal-title":"J. Clin. Anesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/EJA.0000000000000535","article-title":"Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis","volume":"33","author":"Weibel","year":"2016","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1001\/jama.290.18.2455","article-title":"Efficacy of postoperative epidural analgesia: A meta-analysis","volume":"290","author":"Block","year":"2003","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/ACO.0000000000000866","article-title":"Combined spinal epidural for labour analgesia and caesarean section: Indications and recommendations","volume":"33","author":"Guasch","year":"2020","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_9","first-page":"CD004908","article-title":"Combined spinal-epidural versus spinal anaesthesia for caesarean section","volume":"10","author":"Simmons","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/bja\/87.1.62","article-title":"Effect of postoperative analgesia on surgical outcome","volume":"87","author":"Kehlet","year":"2001","journal-title":"Br. J. Anaesth."},{"key":"ref_11","first-page":"21","article-title":"Update on best available options in obstetrics anaesthesia: Perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review","volume":"290","author":"Gizzo","year":"2014","journal-title":"Arch Gynecol. Obs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1056\/NEJMct0909254","article-title":"Epidural analgesia for labor and delivery","volume":"362","author":"Hawkins","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1093\/bmb\/ldr050","article-title":"Overview of anesthetic considerations for Cesarean delivery","volume":"101","author":"Rollins","year":"2012","journal-title":"Br. Med. Bull."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1017\/S026502150200008X","article-title":"Magnesium infusion reduces perioperative pain","volume":"19","author":"Kara","year":"2002","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1097\/ALN.0b013e31828e156f","article-title":"Predicting acute pain after cesarean delivery using three simple questions","volume":"118","author":"Pan","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1097\/00003643-200411000-00003","article-title":"Combined epidural\/spinal anaesthesia: Needle-through-needle or separate spaces?","volume":"21","author":"Backe","year":"2004","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1213\/ANE.0b013e318222abe4","article-title":"Ultrasound assessment of the vertebral level of the intercristal line in pregnancy","volume":"113","author":"Lee","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1111\/anae.12034","article-title":"Assessment of block height for satisfactory spinal anaesthesia for caesarean section","volume":"67","author":"Ousley","year":"2012","journal-title":"Anaesthesia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ijoa.2017.04.001","article-title":"Optimal intrathecal hyperbaric bupivacaine dose with opioids for cesarean delivery: A prospective double-blinded randomized trial","volume":"31","author":"Onishi","year":"2017","journal-title":"Int. J. Obs. Anesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/bja\/aen103","article-title":"Assessment of pain","volume":"101","author":"Breivik","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: A systematic literature review","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/bja\/aew466","article-title":"Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state","volume":"118","author":"Myles","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_23","first-page":"514","article-title":"Neuraxial anesthesia for pain control after cesarean section: A prospective randomized trial comparing three different neuraxial techniques in clinical practice","volume":"82","author":"Kaufner","year":"2016","journal-title":"Minerva Anestesiol."},{"key":"ref_24","unstructured":"Chestnut, D.H., Wong, C.A., Tsen, L.C., Kee, W.D.N., Beilin, Y., Mhyre, J., Bateman, B.T., Msc, M., and Nathan, N. (2020). Chestnut's Obstetric Anesthesia: Principles and Practice 6th Edition Pr\u00e1ctica, Elsevier."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/anae.12927","article-title":"Assessing the height of block for caesarean section over the past three decades: Trends from the literature","volume":"70","author":"Hoyle","year":"2015","journal-title":"Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"303","DOI":"10.4103\/0970-9185.117045","article-title":"Neuraxial opioid-induced pruritus: An update","volume":"29","author":"Kumar","year":"2013","journal-title":"J. Anaesthesiol. Clin. Pharm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1093\/bja\/aes276","article-title":"Evidence-based analysis of risk factors for postoperative nausea and vomiting","volume":"109","author":"Apfel","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/EJA.0000000000000011","article-title":"Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia: A randomised, placebo-controlled study","volume":"31","author":"Nie","year":"2014","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.bja.2018.06.011","article-title":"Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery","volume":"122","author":"Ciechanowicz","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1097\/ALN.0b013e318289b84b","article-title":"Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15","volume":"118","author":"Stark","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5783817","DOI":"10.1155\/2016\/5783817","article-title":"Predictors for moderate to severe acute postoperative pain after cesarean section","volume":"2016","author":"Borges","year":"2016","journal-title":"Pain Res. Manag."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1093\/bja\/aes517","article-title":"Pain vs comfort scores after caesarean section: A randomized trial","volume":"110","author":"Chooi","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ajogmf.2019.04.002","article-title":"Comparison of 3 protocols for analgesia control after cesarean delivery: A randomized controlled trial","volume":"1","author":"Dafna","year":"2019","journal-title":"Am. J. Obs. Gynecol. MFM"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"685","DOI":"10.5114\/aoms.2011.24140","article-title":"Patient-controlled epidural analgesia after Caesarean section: Levobupivacaine 0.15% versus ropivacaine 0.15% alone or combined with fentany l 2 microg\/mL: A comparative study","volume":"7","author":"Matsota","year":"2011","journal-title":"Arch Med. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.tjog.2018.04.004","article-title":"Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial","volume":"57","author":"Maged","year":"2018","journal-title":"Taiwan J Obs. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"574493","DOI":"10.3389\/fphar.2020.574493","article-title":"Analgesic effect comparison between nalbuphine and sufentanil for patient-controlled intravenous analgesia after cesarean section","volume":"11","author":"Sun","year":"2020","journal-title":"Front. Pharm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1213\/01.ane.0000167774.36833.99","article-title":"Patient preferences for anesthesia outcomes associated with cesarean delivery","volume":"101","author":"Carvalho","year":"2005","journal-title":"Anesth. Analg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"10927","DOI":"10.1038\/srep10927","article-title":"A comparision of nalbuphine with morphine for analgesic effects and safety: Meta-analysis of randomized controlled trials","volume":"5","author":"Zeng","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/AJP.0000000000000211","article-title":"Nalbuphine for treatment of opioid-induced pruritus: A systematic review of literature","volume":"32","author":"Jannuzzi","year":"2016","journal-title":"Clin. J. Pain"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/BF03017327","article-title":"Intravenous tenoxicam reduces uterine cramps after cesarean delivery","volume":"49","author":"Huang","year":"2002","journal-title":"Can. J. Anaesth."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/ca.20636","article-title":"An evidence-based approach to human dermatomes","volume":"21","author":"Lee","year":"2008","journal-title":"Clin. Anat."},{"key":"ref_42","unstructured":"Chestnut, D.H., Wong, C.A., Tsen, L.C., Kee, W.D.N., Beilin, Y., Mhyre, J., Nathan, N., and Bateman, B.T. (2019). Chestnut's Obstetric Anesthesia: Principles and Practice, Elsevier."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1213\/ANE.0000000000001255","article-title":"The effect of intrathecal morphine dose on outcomes after elective cesarean delivery: A meta-analysis","volume":"123","author":"Sultan","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1093\/bja\/aes261","article-title":"A prospective cohort study comparing early opioid requirement between Chinese from Hong Kong and Caucasian Australians after major abdominal surgery","volume":"109","author":"Konstantatos","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/bja\/aeg249","article-title":"Epidural versus intrathecal morphine for postoperative analgesia after caesarean section","volume":"91","author":"Duale","year":"2003","journal-title":"Br. J. Anaesth."},{"key":"ref_46","first-page":"392","article-title":"Morphine for post-caesarean section analgesia: Intrathecal, epidural or intravenous?","volume":"46","author":"Lim","year":"2005","journal-title":"Singap. Med. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1213\/00000539-200208000-00037","article-title":"A double-blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery","volume":"95","author":"Sarvela","year":"2002","journal-title":"Anesth. Analg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/papr.12099","article-title":"Spinal opioid bioavailability in postoperative pain","volume":"14","author":"Bujedo","year":"2014","journal-title":"Pain Pr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/00000542-200002000-00011","article-title":"Lumbar epidural morphine in humans and supraspinal analgesia to experimental heat pain","volume":"92","author":"Angst","year":"2000","journal-title":"Anesthesiology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.anclin.2016.09.010","article-title":"Optimal pain management after cesarean delivery","volume":"35","author":"Sutton","year":"2017","journal-title":"Anesth. Clin."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40981-020-00405-9","article-title":"An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal-epidural anesthesia: A retrospective study","volume":"7","author":"Murata","year":"2021","journal-title":"JA Clin. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1213\/ANE.0000000000001628","article-title":"Epidural local anesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting, and pain after abdominal surgery: A cochrane review","volume":"123","author":"Guay","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00586-003-0586-z","article-title":"Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans","volume":"13","author":"Tan","year":"2004","journal-title":"Eur. Spine J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1097\/ALN.0b013e318210f9f8","article-title":"Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade","volume":"114","author":"Chin","year":"2011","journal-title":"Anesthesiology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/bjaceaccp\/mkh006","article-title":"Thoracic epidural anaesthesia and analgesia","volume":"4","author":"McLeod","year":"2004","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1093\/bja\/aev432","article-title":"Epidural distribution of dye administered via an epidural catheter in a porcine model","volume":"116","author":"Mowat","year":"2016","journal-title":"Br. J. Anaesth."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/11\/1099\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:21:22Z","timestamp":1760167282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/11\/1099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,27]]},"references-count":56,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jpm11111099"],"URL":"https:\/\/doi.org\/10.3390\/jpm11111099","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,27]]}}}