title: Incidence and characteristics of breakthrough pain in parturients using computer-integrated patient-controlled epidural analgesia.
abstract: BACKGROUND
  The computer-integrated patient-controlled epidural analgesia (CIPCEA) system can automatically adjust the background infusion rate during combined spinal-epidural analgesia based on the parturient's need, as labor progresses.
  
  
  OBJECTIVE
  The objective is to identify risk factors associated with breakthrough pain during labor as well as identify obstetric and fetal outcomes that are affected by breakthrough pain.
  
  
  METHODS
  This is a retrospective review of prospectively collected data.
  
  
  METHODS
  The setting is in a delivery room.
  
  
  METHODS
  The participants are 280 nulliparous women in early labor (≤5 cm cervical dilatation) who received combined spinal-epidural analgesia with CIPCEA.
  
  
  METHODS
  The intervention is CIPCEA.
  
  
  METHODS
  The primary outcome is the incidence of breakthrough pain (≥1 episodes of pain or pressure that required supplemental epidural medications) during labor. Relevant demographic, anesthetic, obstetric, and fetal characteristics were also measured. Univariate and multivariate analyses were performed to identify obstetric and anesthetic factors that were associated with increased incidence of breakthrough pain as well as to evaluate the impact of breakthrough pain on obstetric and fetal outcomes.
  
  
  RESULTS
  The incidence of breakthrough pain was 9.6%. Independent factors associated with incidence of breakthrough pain are the presence of dysfunctional labor, increased maternal body mass index, and decreased successful-to-total-bolus-demand ratio. The postlabor characteristics independently associated with breakthrough pain were increased duration of labor, decreased duration of effective analgesia, increased total local anesthetic consumption, and decreased maternal satisfaction.
  
  
  CONCLUSIONS
  Low successful to total patient demand bolus ratio was the factor with the strongest association with breakthrough pain. Breakthrough pain was also associated with dysfunctional labor and poorer maternal satisfaction.
authors.affiliation: Consultant Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899; Deputy Head and Senior Consultant Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899; Assistant Professor Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857. Electronic address: sng.ban.leong@kkh.com.sg.
authors.forename: Ban Leong
authors.initials: BL
authors.lastname: Sng
authors.affiliation: Medical Student Duke-NUS Graduate Medical School, 8 College Road, Singapore.
authors.forename: Qianpian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Consultant Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
authors.forename: Wan Ling
authors.initials: WL
authors.lastname: Leong
authors.affiliation: Resident Physician Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ocampo
authors.affiliation: Assistant Professor Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857; Biostatistician Singapore Clinical Research Institute Pte Ltd, 31 Biopolis Way Nanos no. 02-01, Singapore 138669.
authors.forename: Pryseley Nkouibert
authors.initials: PN
authors.lastname: Assam
authors.affiliation: Chairman of Medical Board and Senior Consultant, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899; Professor Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857.
authors.forename: Alex Tiong Heng
authors.initials: AT
authors.lastname: Sia
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D059390:Breakthrough Pain / Q000453:epidemiology*; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D015994:Incidence; D048949:Labor Pain / Q000188:drug therapy; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local
keywords: Analgesia; Epidural; Labor; Neuraxial; Obstetrical; Regression