scholarly journals Association of Pain Catastrophizing and Depressive States with Multidimensional Early Labor Pain Assessment in Nulliparous Women Having Epidural Analgesia – A Secondary Analysis

2021 ◽  
Vol Volume 14 ◽  
pp. 3099-3107
Author(s):  
Xiu Ling Jacqueline Sim ◽  
Chin Wen Tan ◽  
Cheng Teng Yeam ◽  
Hon Sen Tan ◽  
Rehena Sultana ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Pain Assessment ◽  
Pain Catastrophizing ◽  
Secondary Analysis ◽  
Labor Pain ◽  
Nulliparous Women ◽  
Depressive States

scholarly journals The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome

2015 ◽  
Vol 68 (3) ◽  
pp. 249 ◽  
Author(s):  
Jae Hee Woo ◽  
Jong Hak Kim ◽  
Guie Yong Lee ◽  
Hee Jung Baik ◽  
Youn Jin Kim ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Labor Pain ◽  
Obstetric Outcome ◽  
Nulliparous Women

Cesarean Delivery

2002 ◽  
Vol 96 (3) ◽  
pp. 546-551 ◽  
Author(s):  
Shiv K. Sharma ◽  
James M. Alexander ◽  
Gary Messick ◽  
Steven L. Bloom ◽  
Donald D. McIntire ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Epidural Analgesia ◽  
Labor Pain ◽  
Cesarean Deliveries ◽  
Nulliparous Women ◽  
Lower Pain ◽  
Intravenous Analgesia ◽  
Obstetric Management ◽  
Labor Epidural ◽  
To Receive

Background Controversy concerning increased cesarean births as a result of epidural analgesia for relief of labor pain has been attributed, in large part, to difficulties interpreting published studies because of design flaws. In this study, the authors compared epidural analgesia to intravenous meperidine analgesia using patient-controlled devices during labor to evaluate the effects of labor epidural analgesia, primarily on the rate of cesarean deliveries while minimizing limitations attributable to study design. Methods Four hundred fifty-nine nulliparous women in spontaneous labor at term were randomly assigned to receive either epidural analgesia or intravenous meperidine analgesia. Epidural analgesia was initiated with 0.25% bupivacaine and was maintained with 0.0625% bupivacaine and fentanyl 2 microg/ml at 6 ml/h with 5-ml bolus doses every 15 min as needed using a patient-controlled pump. Women in the intravenous analgesia group received 50 mg meperidine with 25 mg promethazine hydrochloride as an initial bolus, followed by 15 mg meperidine every 10 min as needed, using a patient-controlled pump. A written procedural manual that prescribed the intrapartum obstetric management was followed for each woman randomized in the study. Results A total of 226 women were randomized to receive epidural analgesia, and 233 women were randomized to receive intravenous meperidine analgesia. Protocol violations occurred in 8% (38 of 459) of women. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 7% [16 of 226; 95% confidence interval, 4-11%] vs. intravenous meperidine analgesia, 9% [20 of 233; 95% confidence interval, 5-13%]; P = 0.61). Significantly more women randomized to epidural analgesia had forceps deliveries compared with those randomized to meperidine analgesia (12% [26 of 226] vs. 3% [7 of 233]; P < 0.001). Women who received epidural analgesia reported lower pain scores during labor and delivery compared with women who received intravenous meperidine analgesia. Conclusions Epidural analgesia compared with intravenous meperidine analgesia during labor does not increase cesarean deliveries in nulliparous women.

Analgesia for Labor Pain

2000 ◽  
Vol 92 (3) ◽  
pp. 841-850 ◽  
Author(s):  
Alex Macario ◽  
W. Craig Scibetta ◽  
John Navarro ◽  
Ed Riley
Keyword(s):  
Epidural Analgesia ◽  
Cost Model ◽  
Secondary Analysis ◽  
Labor Pain ◽  
Nursing Interventions ◽  
Accounting System ◽  
Expected Cost ◽  
Intravenous Analgesia ◽  
Nursing Costs ◽  
The Cost

Background Epidural analgesia and intravenous analgesia with opioids are two techniques for the relief of labor pain. The goal of this study was to develop a cost-identification model to quantify the costs (from society's perspective) of epidural analgesia compared with intravenous analgesia for labor pain. Because there is no valid method to assign a dollar value to differing levels of analgesia, the cost of each technique can be compared with the analgesic benefit (patient pain scores) of each technique. Methods The authors created a cost model for epidural and intravenous analgesia by reviewing the literature to determine the rates of associated clinical outcomes (benefit of each technique to produce analgesia) and complications (e.g., postdural puncture headache). The authors then analyzed data from their institution's cost-accounting system to determine the hospital cost for parturients admitted for delivery, estimated the cost of each complication, and performed a sensitivity analysis to evaluate the cost impact of changing key variables. A secondary analysis was performed assuming that the cost of nursing was fixed (did not change depending on the number of nursing interventions). Results If the cesarean section rate equals 20% for both intravenous and epidural analgesia, the additional expected cost per patient to society of epidural analgesia of labor pain ranges from $259 (assuming nursing costs in the labor and delivery suite do not vary with the number of nursing interventions) to $338 (assuming nursing costs do increase as the number of interventions increases) relative to the expected cost of intravenous analgesia for labor pain. This cost difference results from increased professional costs and complication costs associated with epidural analgesia. Conclusions Epidural analgesia is more costly than intravenous analgesia. How the cost of the anesthesiologist and nursing care is calculated affects how much more costly epidural analgesia is relative to intravenous analgesia. Published studies have determined that epidural analgesia provides relief of labor pain superior to intravenous analgesia, quantified in one study as 40 mm better on a 100-mm scale during the first stage of labor and 29 mm better during the second stage of labor. Patients, physicians, and society need to weigh the value of improved pain relief from epidural analgesia versus the increased cost of epidural analgesia.

scholarly journals Impact of Epidural Analgesia at Different Cervical Dilation on the Rate of Cesarean Delivery

2014 ◽  
Vol 7 (2) ◽  
pp. 153-166
Author(s):  
Xiaofeng Shen
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Labor Pain ◽  
High Rate ◽  
Care Hospital ◽  
Cervical Dilation ◽  
Maternal Characteristics ◽  
Nulliparous Women ◽  
Significant Difference

BACKGROUND: Epidural analgesia is the optimal means in controlling labor pain, whereas the correlation between epidural analgesia at different cervix dilation and corresponding risk of operative delivery remains unclear. OBJECTIVE: The aim of this study was to investigate the association between the epidural analgesia at different cervix and the rate of Cesarean in nulliparous women. METHODS: This is a perspective controlled trial conducted in a University affiliated tertiary women’s health care hospital. After approval by the Institutional Ethical Committee, 780 nulliparous women who underwent spontaneous vaginal delivery at term requesting labor analgesia were screened and 596 of them were assigned into interventions. Subjects were allocated into one of four groups received epidural analgesia initiated at different cervical dilation, i.e. from the onset of painful uterine contraction to the cervix 50.0 mm or greater. The primary outcome was the rate of Cesarean delivery. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery. RESULTS: Five hundred and thirty three subjects completed the study. Significant difference in the rate of Cesarean delivery was observed amongst the four groups (98.9% at cervix <= 10.0mm, 30.2% at cervix 11.0 – 30.0mm, 24.2% at cervix 31.0 – 50.0mm and 18.1% at cervix >= 51.0mm, P < 0.0001). The major reason led to high Cesarean rate at cervix <= 10.0 mm was poor labor progression (75.2%). No significant differences were expressed in variables of non-reassuring fetal status. CONCLUSIONS: Epidural analgesia should be avoided in controlling labor pain at the cervix below 10.0mm due to its influence on the progress of labor resulting in high rate of Cesarean. Maternal characteristics are additional aspects need to be concerned during epidural labor control in nulliparous women. TRIAL REGISTRATION: Epidural Analgesia in Different Cervix Diameter and the Rate of Cesarean Delivery (EACDRCD). ClinicalTrials.gov ID, NCT00677274. http://clinicaltrials.gov/ct2/show/NCT00677274.

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