Incidence and characteristics of breakthrough pain in parturients using computer-integrated patient-controlled epidural analgesia

• Published in: Journal of clinical anesthesia 2015-06, Vol.27 (4), p.277-284
• Main Authors: Sng, Ban Leong, MMED, FANZCA, FFPMANZCA, MCI, Zhang, Qianpian, BA, Leong, Wan Ling, FANZCA, Ocampo, Cecilia, MD, Assam, Pryseley Nkouibert, PhD, Sia, Alex Tiong Heng, MMED, FAMS
• Format: Article
• Language: English
• Subjects: Adult; Analgesia; Analgesia, Epidural - methods; Analgesia, Obstetrical - methods; Analgesia, Patient-Controlled - methods; Anesthesia & Perioperative Care; Anesthetics, Local - administration & dosage; Breakthrough Pain - epidemiology; Cesarean section; Drug Therapy, Computer-Assisted; Epidural; Female; Humans; Incidence; Labor; Labor Pain - drug therapy; Neuraxial; Obstetrical; Pain management; Pain Medicine; Patient satisfaction; Pregnancy; Regression; Retrospective Studies; Studies; Transdermal medication; Women
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2015.01.003

Abstract Introduction The computer-integrated patient-controlled epidural analgesia (CIPCEA) system can automatically adjust the background infusion rate during combined spinal-epidural analgesia based on the parturient's need, as labor progresses. Objectives The objective is to identify risk factors associated with breakthrough pain during labor as well as identify obstetric and fetal outcomes that are affected by breakthrough pain. Design This is a retrospective review of prospectively collected data. Setting The setting is in a delivery room. Participants The participants are 280 nulliparous women in early labor (≤ 5 cm cervical dilatation) who received combined spinal-epidural analgesia with CIPCEA. Interventions The intervention is CIPCEA. Measurements The primary outcome is the incidence of breakthrough pain (≥ 1 episodes of pain or pressure that required supplemental epidural medications) during labor. Relevant demographic, anesthetic, obstetric, and fetal characteristics were also measured. Univariate and multivariate analyses were performed to identify obstetric and anesthetic factors that were associated with increased incidence of breakthrough pain as well as to evaluate the impact of breakthrough pain on obstetric and fetal outcomes. Results The incidence of breakthrough pain was 9.6%. Independent factors associated with incidence of breakthrough pain are the presence of dysfunctional labor, increased maternal body mass index, and decreased successful-to-total-bolus-demand ratio. The postlabor characteristics independently associated with breakthrough pain were increased duration of labor, decreased duration of effective analgesia, increased total local anesthetic consumption, and decreased maternal satisfaction. Conclusions Low successful to total patient demand bolus ratio was the factor with the strongest association with breakthrough pain. Breakthrough pain was also associated with dysfunctional labor and poorer maternal satisfaction.