///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Evaluating the role of acute pain versus cervical dilation in patient preferences for requesting epidural analgesia

Abstract Number: T210-444
Abstract Type: Original Research

Davin Singh MD1 ; Catherine Gao BA2; Daniel Pinto PhD3; Paul Fitzgerald RN4; Paloma Toledo MD5

Introduction:

Neuraxial labor analgesia is the most effective way to manage labor pain. Several factors may influence the decision and timing of using epidural analgesia including pain, proximity to delivery, or other factors. Patients are often dissatisfied with long delays between analgesia request and delivery. Yet, on busy labor and delivery units, anesthesiologists must prioritize when multiple patients request epidural analgesia simultaneously. Therefore, the objective of this study was to evaluate patients’ preferences for the timing of epidural labor analgesia. We hypothesize that pain is more important than cervical dilation in patient’s willingness to wait for neuraxial labor analgesia.

Methods:

English-speaking women who received neuraxial labor analgesia were approached postpartum. Participants completed a survey which asked about demographic information, cervical dilation and pain score at the time they requested their labor epidural, their attitudes and beliefs about timing intervals, and an adaptive conjoint analysis to determine preferences for epidural analgesia timing. The conjoint analysis presented ‘choice sets’ where respondents chose between two alternative combinations of pain scores and cervical dilations (i.e. attributes) and answered “In which of these scenarios are you more likely to find a longer wait time for epidural anesthesia acceptable.” Preference values, or part-worth utilities, represent the relative importance of each attribute, were calculated using linear models. The primary outcome was the preference value for pain versus cervical dilation in the timing of epidural anesthesia.

Results:

Three hundred women were enrolled in the study and three women were excluded. Pain was weighted 1.6 times more important than cervical dilation in preference values from the conjoint analysis. The median pain score at epidural analgesia request was 8 (interquartile range [IQR]: 6 - 9), and the median cervical dilation was 4 cm (IQR: 4 – 5 cm). The median time women expected to wait between analgesia request and epidural catheter placement was 20 minutes (IQR: 15 – 30 min), while the median time they were willing to wait was 30 minutes (IQR: 20 – 45 min). The median perceived actual wait time was 15 minutes (IQR: 10 – 20 min).

Discussion:

The important finding of this study is that pain is more important to patients than cervical dilation when requesting epidural analgesia, and patients with higher pain scores are less willing to tolerate a delay in epidural catheter placement. While there is not a standard interval between request and neuraxial placement, organizations have suggested intervals of 20 – 30 minutes, which are shown in this study to be acceptable for patients. Aligning patient preferences, and prioritizing epidural catheter placement in patients by higher pain scores rather than cervical dilation may result in improved patient satisfaction.

SOAP 2019