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Scapular Pain and Patient Controlled Analgesia: A retrospective chart review with control comparison.
Abstract Number: F-16
Abstract Type: Original Research
Mid-back, scapular, and neck pain have been reported by patients in association with administration of medications in the epidural space. Proposed mechanisms for this pain include epidural space pressure increases, older age, or elevated body mass index(BMI).
Patients were retrospectively identified using our institution’s anesthesia quality assurance database for the period of October 2009 to October 2010. The patients were matched to a control patient by identifying the closest patient having epidural analgesia for labor in the same obstetric practice. Basic patient demographic data were collected. Amount of physician administered boluses, basal rate, and duration of infusion were determined. Epidural start time to initial complaint of scapular pain was recorded. Statistical analysis of data was performed using paired T-tests.
There were no significant differences between groups for age, gestational age, cervical dilation, or parity. BMI showed a significant difference (p=0.0376). The overall duration in the pain group was significantly longer(p=0.0387). The duration of the basal rate until time of scapular pain showed no significance. One control group patient was an outlier with an epidural in place for 20.5 hours and total volume of 243 ml. Repeat statistical analysis without this patient showed the time to scapular pain as significant(p=0.037). When re-evaluating the total volume delivered to patients before pain, the amount given was also significant(p=0.026).
In the current study, patients who developed pain had longer time of epidural infusion and higher BMI. Other demographic data such as age, parity, or gestational age were not different between groups. When the pain group total volume was compared to the control group without the outlier patient, a significant inter-group difference was noted. This may be an indication that higher epidural space pressures cause scapular pain, and perhaps a higher BMI leads to lower epidural space compliance.
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