JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Hess, P. E. Articles by Sarna, M. C. Search for Related Content PubMed PubMed Citation Articles by Hess, P. E. Articles by Sarna, M. C. Related Collections Obstetrics Pain

---

OBSTETRIC ANESTHESIA

Predictors of Breakthrough Pain During Labor Epidural Analgesia

Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Address correspondence and reprint requests to Philip E. Hess, Ste. 308, Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. Address e-mail to phess{at}caregroup.harvard.edu

Parturients who receive labor epidural analgesia may experience breakthrough pain that requires supplemental medications. We investigated the factors associated with breakthrough pain. This prospective observational study included 1963 parturients who received epidural analgesia. Subjects were categorized into two groups on the basis of the number of episodes of breakthrough pain: the Recurrent Breakthrough Pain (RBP) group experienced three or more episodes. Univariate and multivariate regression analyses were used to evaluate factors associated with the RBP group. By multivariate analysis, nulliparity, heavier fetal weight, and epidural catheter placement at an earlier cervical dilation were found to be independently associated with the RBP group. These factors may predict which parturients’ analgesia may be complicated by breakthrough pain. Parturients who received a combined spinal/epidural technique were less likely to be associated with the RBP group. The combined spinal/epidural technique may be superior to conventional epidural anesthesia, because breakthrough pain occurred less often. It is interesting to note that the characteristics that are associated with the RBP group are similar to those that have been associated with increased severity of maternal pain.

IMPLICATIONS: Nulliparity, heavier fetal weight, and epidural catheter placement at an early cervical dilation are predictors of breakthrough pain during epidural labor analgesia. The combined spinal/epidural technique may be associated with a decreased incidence of breakthrough pain.

This article has been cited by other articles:

				C. A. Wong, B. M. Scavone, A. M. Peaceman, R. J. McCarthy, J. T. Sullivan, N. T. Diaz, E. Yaghmour, R-J. L. Marcus, S. S. Sherwani, M. T. Sproviero, et al. The Risk of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor N. Engl. J. Med., February 17, 2005; 352(7): 655 - 665. [Abstract] [Full Text] [PDF]

				A. Caraceni, C. Martini, E. Zecca, R. K Portenoy, and a Working Group of an IASP Task Force on Cancer Pa Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey Palliative Medicine, April 1, 2004; 18(3): 177 - 183. [Abstract] [PDF]

				P. E. Hess, A. Vasudevan, C. Snowman, and S. D. Pratt Small Dose Bupivacaine-Fentanyl Spinal Analgesia Combined with Morphine for Labor Anesth. Analg., July 1, 2003; 97(1): 247 - 252. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999