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Evaluation of association factors for labor episodic pain during epidural analgesia

Authors Chan JJI, Gan YY, Dabas R, Han NLR, Sultana R, Sia ATH, Sng BL

Received 23 August 2018

Accepted for publication 29 December 2018

Published 15 February 2019 Volume 2019:12 Pages 679—687


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Jason Ju In Chan,1 Yuan Ying Gan,2 Rajive Dabas,1 Nian-Lin Reena Han,3 Rehena Sultana,4 Alex Tiong Heng Sia,1,2 Ban Leong Sng1,2

1Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore; 2Duke-NUS Medical School, Singapore; 3Division of Clinical Support Services, KK Women’s and Children’s Hospital, Singapore; 4Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore

Purpose: Epidural analgesia provides safe and effective labor pain relief. However, labor episodic pain can occur during epidural analgesia, requiring epidural top-ups, and may result in decreased patient satisfaction. The primary aim of our study was to investigate the factors associated with labor episodic pain during epidural analgesia.
Patients and methods: Electronic and hardcopy records of labor deliveries between January 2012 and December 2015 were reviewed at KK Women’s and Children’s Hospital, Singapore. The primary outcome was the prevalence of episodic pain. Demographic, clinical and anesthetic data were retrieved. Univariate and multivariate logistic regression analyses were used to identify associated risk factors for labor episodic pain experienced by parturients while receiving epidural analgesia. Model performance was assessed by area under the curve (AUC) from the receiver operating characteristic curve.
Results: The prevalence of labor episodic pain was 14.2% (2,951 of 20,798 parturients). The risk factors associated with labor episodic pain, which are given here as factor (OR, 95% CI), are the following: need for epidural resiting (11.4, 7.53–17.28), higher pain scores intrapartum (1.34, 1.32–1.36), higher Bromage scores (1.12, 1.02–1.22), the need for instrumental delivery (1.32, 1.16–1.52), the need for cesarean delivery (1.41, 1.26–1.59), the presence of venous puncture (1.29, 1.03–1.62), the presence of dural puncture (14.28, 5.92–34.43), the presence of high block (6.05, 1.39–26.35), the need for a urinary catheter (1.17, 1.17–1.34), larger volumes of local anesthetics used (1.01, 1.01–1.01) and higher body mass index (1.01, 1.01–1.02), and decreased maternal satisfaction (0.97, 0.97–0.98). The AUC was 0.80.
Conclusion: Knowledge of these factors may allow for future interventions in management to prevent labor episodic pain. Further research is needed to validate these association factors.

Keywords: epidural, labor, labor pain, factors, anesthesia, model

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