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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Ethnic Differences in Labor Epidural Request and Subsequent Pain Relief

Abstract Number: F 4
Abstract Type: Original Research

Sylvia H Wilson MD1 ; Matthew P Elliott MD2; Latha Hebbar MD, FRCA3

Background: As the ethnic and racial diversity of Americans increases, it is imperative that we understand these populations' expectations and concerns regarding labor anesthesia. The objective of our study was to analyze ethnic differences in labor analgesia characteristics with regards to timing of continuous labor epidural (CLE) placement and the degree of pain relief in our Hispanic and Non-Hispanic parturients.

Methods: 397 parturients were enrolled in this IRB approved prospective study. Data collected included patients’ race/ethnicity, cervical dilation within one hour of CLE placement and numeric pain scores (0-10) upon CLE placement and after analgesia was established. Data was also collected on parturients’ primary language, formal education, source of labor epidural education, obstetric provider, insurance status, method of delivery, use of induction medications, use of intravenous pain medicines and initial labor plan.

Results: Ethnicity, pain after CLE placement, parity, education level, source of CLE education, labor augmentation, final delivery method, and reason for epidural placement significantly influenced timing of CLE request. Numeric pain scores did not differ prior to CLE placement (median = 8; p = 0.133). However, numeric pain scores were greater in Hispanic parturients (median = 4) compared with Non-Hispanic parturients (median = 3) after adequate CLE analgesia was established (p = 0.006). At the time of CLE placement, Hispanic parturients had significantly greater cervical dilation (Mean ± SD; 4.01 ± 1.96 cm) compared with Non-Hispanic parturients (3.32 ± 1.88 cm; p=0.019). Mean cervical dilation continued to be 0.59 cm greater in Hispanic parturients relative to Non-Hispanic parturients at the time of CLE placement after controlling for education, reason for placement, labor augmentation, final mode of delivery, and insurance status in a multivariate regression model (SE = 0.28; p =0.040).

Conclusions: Our data indicate that Hispanic parturients requested CLEs later in labor than Non-Hispanic groups despite equal reported pain scores. These findings may be due to a lack of appropriate education on labor analgesia and suggests that anesthesia providers need to facilitate improvements in minority patient education about labor analgesia.

SOAP 2013