title: Inadequate pain relief with labor epidurals: a multivariate analysis of associated factors.
abstract: BACKGROUND
  Labor epidural analgesia providing inadequate pain relief may cause maternal dissatisfaction and may fail to produce effective anesthesia when topped up for operative delivery. This study looked at factors associated with inadequate labor epidural analgesia.
  
  
  METHODS
  Data were prospectively collected from 275 parturients receiving labor epidural analgesia. Pain was assessed 30 min after epidural insertion using a verbal pain scale of 0 to 100. A score of 10 or more was considered to represent inadequate pain relief. Sixteen factors chosen by experienced obstetric anesthesiologists for their association with inadequate labor epidural analgesia were studied.
  
  
  RESULTS
  Fifteen parturients were excluded. Forty-four of the remainder (16.9%) experienced inadequate pain relief. Multiparity, history of a previous failure of epidural analgesia, the use of air for loss of resistance, cervical dilatation >7 cm at insertion all had a statistically significant association with inadequate epidural analgesia (P<0.05). Logistic regression showed that cervical dilatation >7 cm, a history of opioid tolerance, a previous failed epidural and insertion of the epidural by a trainee anesthesiologist increased the odds ratio for inadequate pain relief.
  
  
  CONCLUSIONS
  The final model correctly classified 93% of the epidurals that provided effective analgesia but classified only 9.3% of those providing inadequate pain relief. This information can be used to develop a predictive score and change practice resulting in fewer inadequate epidurals.
authors.affiliation: Department of Anesthesia, BC Women's Hospital, Vancouver BC, Canada. ravi.agaram@ggc.scot.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Agaram
authors.forename: M J
authors.initials: MJ
authors.lastname: Douglas
authors.forename: R A
authors.initials: RA
authors.lastname: McTaggart
authors.forename: V
authors.initials: V
authors.lastname: Gunka
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000523:psychology; D016362:Analgesia, Obstetrical / Q000379:methods* / Q000523:psychology; D000701:Analgesics, Opioid; D002983:Clinical Competence; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D015999:Multivariate Analysis; D010147:Pain Measurement; D010298:Parity; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid