Chan Jason Ju In, Gan Yuan Ying, Dabas Rajive, Han Nian-Lin Reena, Sultana Rehena, Sia Alex Tiong Heng, Sng Ban Leong
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore,
Duke-NUS Medical School, Singapore,
J Pain Res. 2019 Feb 15;12:679-687. doi: 10.2147/JPR.S185073. eCollection 2019.
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.
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.
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.
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.
硬膜外镇痛可安全有效地缓解分娩疼痛。然而，硬膜外镇痛期间可能会出现分娩时的间歇性疼痛，需要追加硬膜外用药，这可能会导致患者满意度下降。我们研究的主要目的是调查硬膜外镇痛期间与分娩间歇性疼痛相关的因素。
回顾了新加坡KK妇女儿童医院2012年1月至2015年12月期间分娩的电子和纸质记录。主要结局是间歇性疼痛的发生率。收集了人口统计学、临床和麻醉学数据。采用单因素和多因素逻辑回归分析来确定产妇在接受硬膜外镇痛时经历分娩间歇性疼痛的相关危险因素。通过受试者工作特征曲线的曲线下面积（AUC）评估模型性能。
分娩间歇性疼痛的发生率为14.2%（20798例产妇中有2951例）。与分娩间歇性疼痛相关的危险因素（以下以因素表示，OR，95%CI）如下：需要重新放置硬膜外导管（11.4，7.53 - 17.28）、产时疼痛评分较高（1.34，1.32 - 1.36）、布罗麻评分较高（1.12，1.02 - 1.22）、需要器械助产（1.32，1.16 - 1.52）、需要剖宫产（1.41，1.26 - 1.59）、存在静脉穿刺（1.29，1.03 - 1.62）、存在硬膜穿刺（14.28，5.92 - 34.43）、存在高位阻滞（6.05，1.39 - 26.35）、需要留置尿管（1.17，1.17 - 1.34）、使用的局部麻醉药剂量较大（1.01，1.01 - 1.01）以及体重指数较高（1.01，1.01 - 1.02），以及产妇满意度降低（0.97，0.97 - 0.98）。AUC为0.80。
了解这些因素可能有助于未来在管理中进行干预以预防分娩间歇性疼痛。需要进一步研究来验证这些关联因素。
