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OBSTETRIC ANESTHESIA

Intensity of Labor Pain and Cesarean Delivery

James M. Alexander, MD^*, Shiv K. Sharma, MD, Donald D. McIntire, PhD^*, Jackie Wiley, RN, and Kenneth J. Leveno, MD^*

Departments of *Obstetrics and Gynecology and Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas

Address correspondence and reprint requests to James M. Alexander, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-9032. Address e-mail to jalexa{at}mednet .swmed.edu.

Some authors have suggested that the intensity of labor pain may be related to labor dystocia. We performed a secondary analysis of a previously published randomized investigation of the effects of epidural analgesia during labor compared with patient-controlled IV meperidine on cesarean delivery. Two-hundred-fifty-nine women who received patient-controlled IV meperidine were identified for analysis. All women were in spontaneous labor with a singleton, term gestation. Women requiring 50 mg or more of meperidine per hour during labor were compared with those who required <50 mg/h. In addition, their pain scores (visual analog scale) were compared before and after analgesia administration. Pain scores were significantly higher in women requiring 50 mg/h of meperidine (8.7 vs 8.0, P = 0.05), and their labors tended to be longer (9 vs 5 h, P = 0.09). More cesarean deliveries for obstructed labor were performed in women requiring >50 mg/h of meperidine (14% vs 1.4%, P = 0.001). Neonatal outcomes were similar in the two groups.

Implications: More intense pain during labor, as evidenced by increased self-administered analgesia, is a marker of obstructed labor and the need for cesarean delivery.

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