This prospective cohort study was a secondary analysis of data collected from a clinical trial investigating the efficacy of different epidural delivery–maintenance regimens. The study was conducted between January 2015 and March 2019 in KK Women’s and Children’s Hospital, Singapore on parturients who received epidural analgesia for labor. The study protocol was developed according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines on reporting cohort studies. The study was reviewed and approved by the SingHealth Centralized Institutional Review Board, Singapore (SingHealth CIRB ref 2014/670/D or 2018/3128), and registered on ClinicalTrials.gov (NCT02278601) on October 26, 2014.
The study included nulliparous parturients aged 21–50 years, 36 gestational weeks or more, with a singleton fetus, American Society of Anesthesiologists’ physical status I and II, and in early labor (cervical dilation <5 cm) who had requested epidural labor analgesia. Parturients with multiple pregnancies, noncephalic fetal presentation, obstetric complications (eg, preeclampsia, premature rupture of membranes), contraindications to neuraxial blockade, had received parenteral opioids within 2 hours prior to initiation of epidural analgesia, or had suspected inadvertent dural puncture during initiation of epidural analgesia were excluded.
All epidurals utilized the B Braun Espocan set with a combined spinal–epidural technique using a conventional single interspace needle-through-needle approach. The spinal component was ropivacaine 2mg and fentanyl 15mcg and the epidural infusion solution 0.1% ropivacaine with 2µg/mL of fentanyl. Almost all cases (>99%) were done in the sitting position and utilized a midline approach. The clinical trial involved patients who were placed on patient-controlled epidural analgesia regimens with patient bolus of 5mL per bolus. Once the patient had received epidural labor analgesia and was comfortable, predelivery questionnaires were administered: the PCS, a validated self-reported questionnaire to evaluate the negative thought processes that one may have upon exposure to actual or anticipated pain or painful experiences; the EPDS, a ten-item self-reported questionnaire used as a screening tool for antenatal and PND, scored from 0 to 30, with ≥10 used to indicate clinically significant depressive symptoms15 (link),16 (link) (in our study, this was defined as probable PND and would thus encompass the range of PND states);17 (link) Cohen’s Perceived Stress Scale (PSS), a ten-item validated psychometric instrument to quantify the perception of stress; and Spielberger’s State–Trait–Anxiety Inventory (STAI), a 40-item self-report tool that assesses transient anxiety (state) at the moment of scoring, the dispositional anxiety (trait), and anxiety in general. Parturients’ demographic, obstetric, and epidural analgesia data from medical records were also collected in this study. After patients had delivered, they were interviewed by the anesthetic team for assessment of overall satisfaction with epidural analgesia, as per routine clinical practice. A 20-minute phone survey was conducted at 5–9 weeks postdelivery to obtain postdelivery EPDS and STAI scores.
The study included nulliparous parturients aged 21–50 years, 36 gestational weeks or more, with a singleton fetus, American Society of Anesthesiologists’ physical status I and II, and in early labor (cervical dilation <5 cm) who had requested epidural labor analgesia. Parturients with multiple pregnancies, noncephalic fetal presentation, obstetric complications (eg, preeclampsia, premature rupture of membranes), contraindications to neuraxial blockade, had received parenteral opioids within 2 hours prior to initiation of epidural analgesia, or had suspected inadvertent dural puncture during initiation of epidural analgesia were excluded.
All epidurals utilized the B Braun Espocan set with a combined spinal–epidural technique using a conventional single interspace needle-through-needle approach. The spinal component was ropivacaine 2mg and fentanyl 15mcg and the epidural infusion solution 0.1% ropivacaine with 2µg/mL of fentanyl. Almost all cases (>99%) were done in the sitting position and utilized a midline approach. The clinical trial involved patients who were placed on patient-controlled epidural analgesia regimens with patient bolus of 5mL per bolus. Once the patient had received epidural labor analgesia and was comfortable, predelivery questionnaires were administered: the PCS, a validated self-reported questionnaire to evaluate the negative thought processes that one may have upon exposure to actual or anticipated pain or painful experiences; the EPDS, a ten-item self-reported questionnaire used as a screening tool for antenatal and PND, scored from 0 to 30, with ≥10 used to indicate clinically significant depressive symptoms15 (link),16 (link) (in our study, this was defined as probable PND and would thus encompass the range of PND states);17 (link) Cohen’s Perceived Stress Scale (PSS), a ten-item validated psychometric instrument to quantify the perception of stress; and Spielberger’s State–Trait–Anxiety Inventory (STAI), a 40-item self-report tool that assesses transient anxiety (state) at the moment of scoring, the dispositional anxiety (trait), and anxiety in general. Parturients’ demographic, obstetric, and epidural analgesia data from medical records were also collected in this study. After patients had delivered, they were interviewed by the anesthetic team for assessment of overall satisfaction with epidural analgesia, as per routine clinical practice. A 20-minute phone survey was conducted at 5–9 weeks postdelivery to obtain postdelivery EPDS and STAI scores.
