Factors associated with breakthrough pain with labor epidural analgesia: a single-center prospective study

BACKGROUND: Breakthrough pain requiring anesthesiologist intervention occurs in 14-55% of parturients despite labor epidural analgesia, substantially affecting the childbirth experience. Identifying predictive factors may enable more effective, individualized pain management. METHODS: In this prospective observational study conducted at a tertiary maternity center, 237 parturients received standardized labor epidural analgesia. Breakthrough pain was defined as a patient-reported pain score ≥ 4 on a 0-10 numeric rating scale despite a functioning epidural, unrelieved by patient- controlled epidural analgesia, and requiring anesthesiologist intervention. Univariate and multivariable logistic regression analyses were performed to identify independent predictors. RESULTS: Breakthrough pain occurred in 78 parturients (32.9%). Maternal satisfaction was significantly lower among affected parturients (75.6% vs 95.6% high satisfaction; P < 0.001). Three independent predictors were identified: Rapid labor (odds ratio [OR] 29.41; 95% confidence interval [CI] 9.64-89.71), endometriosis (OR 13.89; 95% CI 1.89-102.04), and cervical dilatation at epidural placement (OR 0.74 per cm; 95% CI 0.63-0.88). CONCLUSIONS: Rapid labor, endometriosis, and early epidural placement independently predict breakthrough pain during labor epidural analgesia. Closer monitoring and anticipatory management in these at-risk parturients may enhance analgesic effectiveness and maternal satisfaction.