Factors Associated with Ineffectiveness of Epidural Analgesia for Labor Pain
Date Issued
2008
Date
2008
Author(s)
Yeh, Yu-Ling
Abstract
Objectives: Labor pain is probably the most painful event in the life of a woman. There are many potential adverse physiological effects of severe labor pain. In recent years, epidural analgesia technique is the most effective and least depressant treatments for labor pain. Previous studies mostly focused on the safety and superiority of epidural analgesia than other techniques. Only very few discussed the factors related to the ineffectiveness of epidural painless labor. To improve patient care and the satisfaction of women in their labor and delivery experience continues to be one of the primary goals and challenges in obstetric analgesia services. In this study we expect to determine the prevalence of epidural analgesia for labor pain and failure rate in Taipei City. Then try to evaluate the factors associated with inadequate pain relief.aterials and Methods: We perform a retrospective chart review in parturients who underwent epidural analgesia for labor pain in Shin-Kong hospital in Taipei City, from January 2005 to December 2006. We retrieved each patient’s demographic characteristics, the course of labor and delivery, and the management of epidural analgesia from medical chart. All participants were divided into training group or validating group. Ineffectiveness of epidural analgesia of labor pain was defined as NRS > 3 at 30 minutes after epidural drug administration. We analyzed the data of the training group. Potential univariate correlated of ineffectiveness epidural analgesia were identified. Then forward stepwise logistic regression analysis was used to select significant ones that might predict the ineffectiveness of epidural painless labor. The ROC (receiver operating characteristic) curve by different cut-off points of this model was done. Then validating group was used to confirm the accuracy of this model. esults: A total of 1015 parturients received the epidural painless labor among the 5809 parturients who gave births during January 2005 to December 2006 in Shin-Kong hospital. The prevalence was 17.47%. The monthly utilization rates were stable in these two years.he failure rate of training group was 26%. The failure group has shorter duration of phase I (310.7 versus 264.43 minutes), more cervical dilatation in 30 minutes (3.25 versus 2.91 cm ), faster progression of cervical dilatation (1.52 versus 0.67 cm/per hour), less instrumentation delivery (11.25% versus 21.69%), and less satisfied (21.77% versus 51.49% pronounced very satisfied) about epidural painless labor. Epidural drugs resulted in significant different between two groups. The failure group used more Lidocaine and Bupivacaine then Ropivacaine as loading drug, and more Bupivacaine then Ropivacaine as continue drug. The predictive model of ineffectiveness epidural painless labor was established. Selective factors were cervical dilatation velocity, loading drugs, and continue drugs. The AUC (area under ROC curve) is calculated as 0.6712. When the cut point of probability is 0.5, the accuracy of validating group was 0.6873. onclusions: This is the first study about the determinants of ineffectiveness epidural analgesia of labor pain in Taiwan. Our results revealed that factors associated with ineffectiveness of epidural analgesia of labor pain are faster cervical dilatation velocity, loading with Lidocaine or Bupivacaine and continue infusion with Bupivacaine. More factors to be concluded in analyses are suggested in further investigation.
Subjects
labor pain
epidural analgesia
painless labor
effectiveness
risk factors
Type
thesis
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