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Intrapartum Interscapular pain during epidural labor analgesia: A Prospective Case Control Study
Abstract Number: F2A-3
Abstract Type: Original Research
Neuraxial analgesia is the most effective method of pain control available to the parturient for labor. A subset women who labor with neuraxial analgesia experience intrapartum intrascapular pain (ISP), severe pain located in the mid-thoracic spine between their scapulae. The incidence of ISP may be between 0.5% and 1%; however, a case series revealed that women who experience ISP have a higher overall cesarean delivery rate than women who do not. We conducted a prospective case-control study to evaluate risk factors for ISP and describe labor outcomes. We hypothesize women who develop ISP will have a higher incidence of cesarean delivery than control patients.
Laboring women who experienced intrascapular pain were recruited for study participation. For each ISP patient, three controls, who did not experience intrascapular pain were recruited. Fifty two ISP patients and 156 controls were required to detect an odds ratio of 2.5 between the cases and controls. Data collected included baseline demographic, medical and obstetric data. Analgesic data included the type of labor analgesia initiated (CSE vs. epidural analgesia), as well as information from the epidural pump (PCEA utilization and total volume of anesthetic used). Labor outcomes were also recorded. The primary outcome was the cesarean delivery rate. Categorical data were compared using a chi-squared statistic. Normal distribution was assessed and continuous data were compared using either a two-tailed t-test or a Kruskal Wallis test.
A total of 52 patients with ISP and 154 controls were recruited. Women with ISP weighed more than controls and were less likely to have a combined spinal-epidural technique for analgesia (Table). Women with ISP were also more likely to undergo cesarean delivery (48% vs 14%, P<0.001). Patients who experienced ISP were also more likely to request and receive PCEA demands, as well as have higher total volume of local anesthetic during labor (183 vs 118 mL, P=0.004).
The development of intrapartum intrascapular pain is associated with a higher cesarean delivery rate, although the etiology is unclear. While the association between ISP and cesarean delivery is not causal, ISP may be a marker for a dysfunctional labor as these women were more likely to request and receive PCEA boluses and utilize more local anesthetic. Future studies should evaluate whether ISP is associated with long-term sequelae, such as neurologic deficits tissue injury.