International journal of obstetric anesthesia · 2025
Factors associated with severe pain during the active phase of pushing despite labor epidural analgesia: a secondary analysis on a prospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Sassi K, Mari M, Denisi S, Ciccarli M, Cambon E, Ysard L, Martin L, Noly M, Guerby P, Minville V
Аннотация
BACKGROUND: A subset of women experience severe pain during vaginal delivery, even with labor epidural analgesia. The objective of this analysis was to identify factors associated with severe pain during the active phase of pushing with analgesia delivered via programmed intermittent epidural bolus (PIEB) and patient-controlled epidural analgesia (PCEA).
METHODS: This pre-specified secondary analysis of a prospective cohort study included 210 women who delivered vaginally with labor epidural analgesia (levobupivacaine 1.25 mg/mL with sufentanil 0.25 μg/mL) at Toulouse University Hospital between February and April 2025. The primary outcome was severe pain during the active phase of pushing, defined as a numeric rating scale (NRS) score ≥ 7. Multivariable logistic regression was used to identify independent associations.
RESULTS: Twenty women (9.5%) experienced severe pain during the active phase of pushing. Factors independently associated with this outcome were rapid cervical change (adjusted OR 4.58, 95% CI 1.59, 13.18, P = 0.005) and fetal macrosomia > 4000 g (adjusted OR 5.23, 95% CI 1.22, 22.41, P = 0.026). Women with severe pain during the active phase of pushing reported lower satisfaction with labor epidural analgesia (median 4.0 vs. 5.0, P < 0.001) and overall pain management (median 4.5 vs. 5.0, P < 0.001).
CONCLUSIONS: In this cohort, 9.5% of women experienced severe pain during the active phase of pushing despite labor epidural analgesia (PIEB and PCEA), which was associated with rapid cervical change and fetal macrosomia. These findings suggest potential roles of incomplete sacral analgesia and enhanced somatic nociception, but require confirmation in future studies.
METHODS: This pre-specified secondary analysis of a prospective cohort study included 210 women who delivered vaginally with labor epidural analgesia (levobupivacaine 1.25 mg/mL with sufentanil 0.25 μg/mL) at Toulouse University Hospital between February and April 2025. The primary outcome was severe pain during the active phase of pushing, defined as a numeric rating scale (NRS) score ≥ 7. Multivariable logistic regression was used to identify independent associations.
RESULTS: Twenty women (9.5%) experienced severe pain during the active phase of pushing. Factors independently associated with this outcome were rapid cervical change (adjusted OR 4.58, 95% CI 1.59, 13.18, P = 0.005) and fetal macrosomia > 4000 g (adjusted OR 5.23, 95% CI 1.22, 22.41, P = 0.026). Women with severe pain during the active phase of pushing reported lower satisfaction with labor epidural analgesia (median 4.0 vs. 5.0, P < 0.001) and overall pain management (median 4.5 vs. 5.0, P < 0.001).
CONCLUSIONS: In this cohort, 9.5% of women experienced severe pain during the active phase of pushing despite labor epidural analgesia (PIEB and PCEA), which was associated with rapid cervical change and fetal macrosomia. These findings suggest potential roles of incomplete sacral analgesia and enhanced somatic nociception, but require confirmation in future studies.