Predictors of Breakthrough Pain During Labor Epidural Analgesia

Hess, Peter; Pratt, Stephen D.; Lucas, Tanya; Miller, Carolyn G.; Corbett, Tanya; Oriol, Nancy E.; Sarna, Mukesh C.

doi:10.1213/00000539-200108000-00036

Cited by 56 publications

(24 citation statements)

References 15 publications

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“…Indications for misoprostol inductions may have changed in recent years, and the low cesarean section rate in our IL group (similar to the SL group) suggests that most labors were probably not dystocia. Dystocia has been shown to increase both analgesia requirement and the cesarean delivery rate [22].…”

Section: Discussionmentioning

confidence: 99%

Genetic variability of the μ-opioid receptor influences intrathecal fentanyl analgesia requirements in laboring women ☆

Landau

Kern

Columb

et al. 2008

Pain

135

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Labor initiates one of the most intensely painful episodes in a woman's life. Opioids are used to provide analgesia with substantial interindividual variability in efficacy. μ-Opioid receptor (μOR, OPRM1) genetic variants may explain differences in response to opioid analgesia. We hypothesized that OPRM1 304A/G polymorphism influences the median effective dose (ED 50 ) of intrathecal fentanyl via combined spinal-epidural for labor analgesia. Nulliparous women were prospectively recruited around 35 weeks gestation (n = 224), and genotyped for 304A/G polymorphism. Those requesting neuraxial labor analgesia were enrolled in one of the two double-blinded trials: up-down sequential allocation (SA, n = 50) and a separate confirmatory random-dose allocation trial (RA, n = 97). Effective analgesia from intrathecal fentanyl was defined by ⩾ 60 min analgesia with verbal rating score ≤1 (scale 0-10) and was compared between μOR 304A homozygotes (Group A) and women carrying at least one 304G allele (Group G). OPRM1 304G allele frequency f(−) was 0.18. Using SA, intrathecal fentanyl ED 50 was 26.8 μg (95% CI 22.7-30.9) in Group A and 17.7 μg (95% CI 13.4-21.9) in Group G (p < 0.001; 304A homozygosity increased the ED 50 1.5-fold). RA confirmed that 304A homozygosity significantly increases intrathecal fentanyl ED 50 (27.4 μg in Group A and 12.8 μg in Group G [p < 0.002; 2.1-fold]). We demonstrate for the first time that the μOR 304G variant significantly reduces intrathecal fentanyl ED 50 for labor analgesia, suggesting women with the G variant may be more responsive to opioids and require less analgesic drugs. These Conflict of interestNone of the authors presents any commercial association or other issues that might pose a conflict of interest. Financial disclosures

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Section: Discussionmentioning

confidence: 99%

Genetic variability of the μ-opioid receptor influences intrathecal fentanyl analgesia requirements in laboring women ☆

Landau

Kern

Columb

et al. 2008

Pain

135

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“…This means a significant reduction in the rate of clinically important hypotension or bradycardia [10,22,[31][32][33][34][35]. Only 1-5% of the subjects having undergone unilateral spinal block suffer, in fact, from clinically important hypotension during surgery [10,31,35]. The reduction in the rate of hypotension has also been shown in elderly patients or those at a high risk from anesthesia [33,34].…”

Section: A Borgeat Balgrist University Hospital Zurich Switzerlandmentioning

confidence: 99%

Abstracts of the XXIX Annual European Society of Regional Anaesthesia (ESRA) Congress 2010

Žarskus¹,

Karbonskienė²,

Rimaitis³

et al. 2010

Regional Anesthesia and Pain Medicine

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“…Moreover, the mixed findings from research on rhythms is partly due to the nature of the experience of pain, whose perception and communication results from multiple synergistic contributions anchored in individual experiences; as such, labour pain is considered a phenomenon of significant individuality (Bonica, 1996). Indeed, the variability of labour pain is affected by demographic and physical variables (Melzack et al, 1984;Hess et al, 2001), the pharmacological management of uterine activity, which is able to increase contractility and pain (Wei et al, 2009) and by psychological dimensions and individual characteristics (Melzack et al, 1984;Saisto & Halmesmaki, 2003). Among the later, a growing body of research has highlighted the relevance of adult attachment in diverse contexts of pain (Meredith et al, 2008;Meredith, 2013).…”

Section: Introductionmentioning

confidence: 99%

The influence of women’s attachment style on the chronobiology of labour pain, analgesic consumption and pharmacological effect

Costa-Martins

Pereira

Martins

et al. 2014

Chronobiology International

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Circadian variation in biological rhythms has been identified as affecting both labour pain and the pharmacological properties of analgesics. In the context of pain, there is also a growing body of evidence suggesting the importance of adult attachment. The purpose of this study was to examine whether labour pain, analgesic consumption and pharmacological effect are significantly affected by the time of day, and to analyse whether this circadian variation is influenced by women's attachment style. This prospective observational study included a sample of 81 pregnant women receiving patientcontrolled epidural analgesia (PCEA). Attachment was assessed with the Adult Attachment ScaleRevised (AAS-R). The perceived intensity of labour pain in the early stage of labour (3 cm of cervical dilatation and before the administration of PCEA) was measured using a visual analogue scale (VAS).Pain was also indirectly assessed by measuring the consumption of anaesthetics. The latency period and the duration of effect were recorded for a chronopharmacology characterisation. Pain, as assessed with the VAS, was significantly higher in the night-time group than in the daytime group. An insecure attachment style was significantly associated with greater labour pain at 3 cm of cervical dilatation (p < 0.001) and before the beginning of analgesia (p < 0.001) as well as with higher analgesic consumption and lower pharmacological efficacy (p < 0.05). The time of day was significantly associated with the pharmacological effect: the latency period was longer at night, and the duration of the pharmacological effect was longer during the daytime. The interaction between time of day and attachment style was not significant for any of the study variables. Our results provide evidence of the importance of circadian variation in studying labour pain and the pharmacological effect of labour analgesia involving epidural blockage with a PCEA regimen. Moreover, although there was no evidence that attachment style influenced the circadian variation, these data emphasise that insecure attachment patterns are a risk factor for greater labour pain and analgesic consumption, which should be considered in pain management approaches.

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Predictors of Breakthrough Pain During Labor Epidural Analgesia

Cited by 56 publications

References 15 publications

Genetic variability of the μ-opioid receptor influences intrathecal fentanyl analgesia requirements in laboring women ☆

Genetic variability of the μ-opioid receptor influences intrathecal fentanyl analgesia requirements in laboring women ☆

Abstracts of the XXIX Annual European Society of Regional Anaesthesia (ESRA) Congress 2010

The influence of women’s attachment style on the chronobiology of labour pain, analgesic consumption and pharmacological effect

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