Interscapular Pain During Epidural Labour Analgesia and Its Associated Risk Factors

Abstract

Introduction: Epidural analgesia is a gold standard for the management of labour pain. Despite that, there was a small incidence of interscapular pain, which can be as severe as contraction pain and interfere with patient manage­ment. This study's objective was to identify possible risk factors associated with interscapular pain during epidural labour analgesia and its delivery outcome. Materials and methods: This study was carried out in the Department of Anaesthesia, Hospital Sultan Ismail, Johor Bharu. A total of 256 parturient who received epidural labour analgesia from January 2017 to December 2019 were recruited. Patients' demographics, epidural technique, local anaesthetic drugs used, and delivery data were recorded. Results: : Simple logistic regression analysis showed primigravida, odds ratio 2.66 (95% CI 1.48, 4.76), maternal obesity, odds ratio 7.73 (95% CI 3.99, 14.97), conventional technique during epidural initiation, odds ratio 4.22 (95% CI 2.29, 7.79) and use of patient controlled epidural analgesia (PCEA) machine, odds ratio 3.62 (95% CI 1.06, 12.31) were associated with increased risk of interscapular pain. However, further analysis showed only high volume of local anaesthetic, odds ratio 29.74 (95% CI 5.12, 172.64) was signifi­cantly associated with increased risk. Moreover, interscapular pain did not significantly associated with the delivery outcome (P = 0.546). Conclusion: A higher volume of local anaesthetic infused epidurally was associated with an increased risk of interscapular pain during epidural labour analgesia. The other risk factors such as primigravida, maternal obesity, conventional epidural, and PCEA machine use showed an association with interscapular pain but did not significantly increase the risk