Risk Factors for Epidural Analgesia Failure and Its Consequences in the Natural Birth Process: An Anesthesia Intervention in Reducing Patients' Pain
,
Abstract
Background: Epidural is a type of regional anesthesia performed by injecting a local anesthetic agent. In this type of anesthesia, by using a catheter in the epidural space, the anesthetic drug can be re-injected if necessary. For this reason, this study was conducted with the aim of determining and investigating the risk factors for epidural analgesia failure (FEA) and its outcomes in the normal labor process of pregnant women referring to Arash Hospital.
Methods: This prospective cohort study evaluated 160 mothers requesting epidural to identify the risk factors for failed epidural analgesia (FEA), where FEA was defined based on the VAS score half an hour after the initial dose. Following thorough pre-anesthesia tests, standard doses were injected using the Loss of Resistance technique, and labor progression and pain (VAS) were monitored periodically. Analyses focused on comparing demographic, technical (physician skill), and obstetric outcome variables between the successful and unsuccessful groups at a significance level of P < 0.05.
Results: A statistically significant difference was observed in the variables of effacement, the length of the first and second stages of labor, and the one-minute Apgar score (P < 0.05) between the successful and unsuccessful groups, indicating that in the unsuccessful group, effacement was less, and the labor stages were longer. Moreover, the unsuccessful group exhibited a greater prevalence of Apgar scores below 7 at the first minute, and a higher incidence of fetal heart rate deceleration was also noted in this group (P = 0.01). However, the mean dilation, mode of delivery, satisfaction scores, and five-minute Apgar scores showed no statistically significant difference. These results emphasize the importance of accurate assessment of variables related to labor progression and fetal status in determining the success of the procedure.
Conclusion: Overall, the results showed significant differences between the successful and unsuccessful groups in the mean effacement, the length of the labor stages, and the one-minute Apgar score, while other variables, such as dilation, mode of delivery, satisfaction, and the five-minute Apgar score, did not show a statistically significant difference. These results show how the success of labor affects the stages of labor and the baby's health in the first few minutes after birth.
[2] Mahmoud IF, Ragab AS, Eita YMS, Abdelmottaleb NA, Elfar BE, Sadek HA, et al. Effect of dexmedetomidine as an adjunct to ultrasound guided modified four-in-one block for perioperative analgesia in arthroscopic knee surgery. J Med Pharm Chem Res. 2026; 8(5):1312-9.
[3] Purnamasari Y, Wardhana TH, Waloejo CS. Comparison of regional anesthesia and general anesthesia on clinical outcomes of upper extremity fracture patients: A systematic review and meta-analysis. J Med Pharm Chem Res. 2026; 8(4):763-78.
[4] Susanti I, Sebayang SM, Burhan A. Impact of ondancentron in intra-anesthesia during caesarean section: A meta-analysis of randomized trials. Java Nurs J. 2024; 2(1):26-42.
[5] Iddrisu M, Khan ZH. Anesthesia for cesarean delivery: general or regional anesthesia—a systematic review. Ain-Shams J Anesthesiol. 2021; 13(1):1.
[6] Al-Husban N, Elmuhtaseb MS, Al-Husban H, Nabhan M, Abuhalaweh H, Alkhatib YM, et al. Anesthesia for cesarean section: retrospective comparative study. Int J Womens Health. 2021; 13:141-52.
[7] Stanisic DM, Kalezic N, Rakic A, Rajovic N, Mostic TI, Cumic J, et al. Comparison of post-cesarean pain perception of general versus regional anesthesia, a single-center study. Medicina. 2022; 59(1):44.
[8] Elsawy AGS, Elshamy MM, Abouelnour ASE, Alfeky AA, Ramadan HSI, Saad MGI, et al. Effect of prophylactic intravenous neostigmine on post-dural puncture headache in parturients undergoing spinal anesthesia for cesarean section: A double-blind randomized placebo-controlled study. J Med Pharm Chem Res. 2026; 8(6):1462-72.
[9] Zhou L, Li J, Zhou Y, Liang Y, Ma Q, Yang L, et al. Pain management for postpartum pain: a narrative review. J Pain Res. 2025; 18:5617-26.
[10] Mohammed S, Lokubal P, Ackah Baafi JA. Intimate partner violence during pregnancy and its association with pregnancy and childbirth complications: A prospective cohort study. PLOS Glob Public Health. 2025; 5(4):e0004311.
[11] Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C, Ocaña-Peinado F. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery. 2015; 31(6):613-6.
[12] Tarjoman A, Vasigh A, Safari S, Borji M. Pain management in neonatal intensive care units: A cross sectional study of neonatal nurses in Ilam City. J Neonatal Nurs. 2019; 25(3):136-8.
[13] Hatefi M, Tarjoman A, Borji M. Do religious coping and attachment to god affect perceived pain? Study of the elderly with chronic back pain in Iran. J Relig Health. 2019; 58(2):465-75.
[14] Hatefi M, Abdi A, Tarjoman A, Borji M. Prevalence of depression and pain among patients with spinal cord injury in Iran: A systematic review and meta-analysis. Trauma Mon. 2019; 24(4):1-8.
[15] Rezaei B, Mousavi E, Heshmati B, Asadi S. Low back pain and its related risk factors in health care providers at hospitals: A systematic review. Ann Med Surg (Lond). 2021; 70:102903.
[16] Prathyusha S, Shankar Gupta P, Kumar AK, Hussain Syed S, Shaik M, Jahnavi P, et al. Theoretical and computational study of bioactive compounds from Myrica nagi as inhibitors of neuroendocrine and opioid receptors: A molecular docking and dynamics approach. Adv J Chem A. 2026; 9(2):223-42.
[17] Ibrahim DMA, Ali WAAE, Morsy HSS, Eid MI, Abdelaziz FM, Salem EA, et al. Ultrasound-guided pectoral nerve block (PEC II) versus serratus anterior plane block (SAPB) for pain control following modified radical mastectomy. J Med Pharm Chem Res. 2026; 8(4):938-52.
[18] Zuarez-Easton S, Erez O, Zafran N, Carmeli J, Garmi G, Salim R. Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. Am J Obstet Gynecol. 2023; 228(5):S1246-S59.
[19] Anim‐Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non‐epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;(5).
[20] Kearns RJ, Shaw M, Gromski PS, Iliodromiti S, Lawlor DA, Nelson SM. Association of epidural analgesia in women in labor with neonatal and childhood outcomes in a population cohort. JAMA Netw Open. 2021; 4(10):e2131683.
[21] Kim W, Hur M, Park S-K, Yoo S, Lim T, Yoon H, et al. Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis. Int J Obstet Anesth. 2019; 37:5-15.
[22] Kang T, Tao J, Wang X, Liu Y, Jin D. Epidural ropivacaine versus bupivacaine for cesarean sections: a system review and meta-analysis. J Matern Fetal Neonatal Med. 2024; 37(1):2313356.
[23] Bakytbekovich ON, Al-Hili A, Hamid Ali D, Kamal Mahmoud A, Hachim Muhammad E, S Abed A, et al. The effect of intervention using stages of change method to improve pap smear screening for cervical cancer. J Obstetrics, Gynecology and Cancer Research. 2023; 8(3):277-84.
[24] Saiwan MJ, Shafik SA, Nizamli FM, Ahmad L, Abdel-Aziz NI, Awarke AH. Effect of a Health Belief Model-Based Educational Program on University Students' Knowledge and Beliefs Regarding Sexual Harassment. International Journal of Body, Mind & Culture (2345-5802). 2025; 12(6).
[25] Li L, Yang Z, Zhang W. Epidural dexmedetomidine for prevention of intrapartum fever during labor analgesia: a randomized controlled trial. Pain Ther. 2021; 10(1):391-400.
[26] Maddali P, Moisi M, Page J, Chamiraju P, Fisahn C, Oskouian R, et al. Anatomical complications of epidural anesthesia: a comprehensive review. Clin Anat. 2017; 30(3):342-6.
[27] Su J, Soliz JM, Popat KU, Gebhardt R. Complications of postoperative epidural analgesia for oncologic surgery: a review of 18,895 cases. Clin J Pain. 2019; 35(7):589-93.
[28] Ashagrie HE, Fentie DY, Kassahun HG. A review article on epidural analgesia for labor pain management: A systematic review. Int J Surg Open. 2020; 24:100-4.
[29] Silva M, Halpern SH. Epidural analgesia for labor: Current techniques. Local Reg Anesth. 2010; 3:143-53.
[30] Khaneshi R, Rasooli S, Moslemi F, Fakour S. Comparison of continuous epidural infusion of bupivacaine and fentanyl versus patient controlled analgesia techniques for labor analgesia: A randomized controlled trial (RCT). J Reprod Infertil. 2020; 21(1):42-8.
[31] Taheri S, Tavousi M, Momenimovahed Z, Direkvand-Moghadam A, Tiznobaik A, Suhrabi Z, et al. Development and psychometric properties of maternal health literacy inventory in pregnancy. PLoS One. 2020; 15(6):e0234305.
[32] Saiwan MJ, Al-showaily JS. Psycho-educational programs: Enhancing coping strategies and mitigating anxiety in chemotherapy patients. Babcock University Medical Journal. 2025;8(2):360-77.
[33] Chao WH, Cheng WS, Hu LM, Liao CC. Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study. BMC Anesthesiol. 2023; 23(1):338.
[34] Li P, Ma X, Han S, Kawagoe I, Ruetzler K, Lal A, et al. Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis. J Matern Fetal Neonatal Med. 2023; 36(2):2278020.
[35] Bauer ME, Kountanis JA, Tsen LC, Greenfield ML, Mhyre JM. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. Int J Obstet Anesth. 2012; 21(4):294-309.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Anesthesia Pain Labor Epidural analgesia | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
