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Anesthetic and Obstetrical Factors Associated With the Effectiveness of Epidural Analgesia for Labor Pain Relief: An Observational Population-Based Study
  1. Marie-Pierre Bonnet, MD, PhD*,,,
  2. Caroline Prunet, MPH,
  3. Christophe Baillard, MD, PhD*,
  4. Laure Kpéa, MPH,
  5. Béatrice Blondel, PhD and
  6. Camille Le Ray, MD, PhD,,§
  1. *Department of Anesthesia and Intensive Care, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris Descartes University, Paris, France
  2. Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
  3. DHU Risks in Pregnancy, Paris, France
  4. §Port Royal Maternity, Hôpitaux Universitaires Paris Centre, AP-HP, Paris Descartes University, Paris, France
  1. correspondence: Marie-Pierre Bonnet, MD, PhD, Department of Anesthesia and Intensive Care, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris Descartes University, Paris, France (e-mail: marie-pierre.bonnet{at}aphp.fr).

Abstract

Background and Objectives The effectiveness of labor epidural analgesia is difficult to explore, as it includes the maternal satisfaction with analgesia as well as the overall childbirth experience. In this population-based study, we sought to identify factors associated with the effectiveness of epidural analgesia for labor pain relief.

Methods We performed a secondary analysis of the 2010 French National Perinatal Survey, a cross-sectional study of a representative sample of births in France. All participants who gave birth with an epidural analgesia were included. Effectiveness of epidural analgesia was assessed 2 to 3 days after delivery and intended to include analgesic efficacy and maternal satisfaction together. The factors analyzed were anesthetic management and maternal, obstetrical, and organizational characteristics, using a logistic regression with random effects model.

Results Among the 9337 women who gave birth with an epidural analgesia and were included, 8377 (89.3%; 95% confidence interval [CI] = 88.7–89.9) considered their epidural to be very or fairly effective. In the multivariate analysis, effectiveness was significantly associated with the use of patient-controlled epidural analgesia (adjusted odds ratio [aOR] = 1.2 [1.0–1.5]; P = 0.02) and delivery in private maternity facilities (aOR = 1.3 [1.1–1.6]); it was significantly less effective in obese women (aOR = 0.6 [0.5–0.8]) and multiparous women not receiving oxytocin during labor (aOR = 0.4 [0.4–0.6]) as compared with nonobese and nulliparous women with oxytocin, respectively.

Conclusions At the population level, most women found epidural analgesia effective for labor pain relief, but specific attention should be paid to obese parturients and multiparous women not receiving oxytocin. High epidural effectiveness with patient-controlled analgesia should promote an increased use of this method.

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Footnotes

  • The authors declare no conflict of interest.

    This work should be attributed to the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France.

    This study was supported by the APICIL Foundation, Lyon, France. The National Perinatal Survey was funded by the French Ministry of Health. We are grateful to the CARO (Obstetric Anesthesia and Critical Care French Association) for the prize we received for this work at the 49th Congress.

    This report was presented in part at the national congress of the French Society of Anesthesiology and Intensive Care (SFAR 2014).

    Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org).