The relationship of preoperative anxiety with failure of extension of epidural analgesia for cesarean section

Background: Patients anesthetized by extension of epidural analgesia during labor frequently experience intraoperative visceral pain during cesarean section.Visceral pain is known to be related to anxiety.We evaluated pain and preoperative anxiety using the numeric rating scale (NRS-11), and examined the relationship of anxiety with failure of extension of epidural analgesia due to intraoperative pain.Methods: Patients received continuous epidural infusion at a rate of 10 ml/h for labor pain.Two percent lidocaine mixed with 100 g fentanyl, 1：200,000 epinephrine, and 2 mEq bicarbonate was injected through the epidural catheter for cesarean section.Failure of epidural anesthesia was defined as the need for conversion to general anesthesia or supplementation with opioids, sedatives, or inhalants after epidural anesthesia for cesarean section.We investigated the relationship of preoperative factors including preoperative anxiety with failure of epidural anesthesia.Results: Heavier weight of parturients, more cervical dilatation at the time of epidural analgesia administration, higher pain NRS score after epidural analgesia, higher pain NRS score before epidural analgesia for cesarean section, and lower rate of iv pethidine due to shivering were associated with a higher failure rate of epidural anesthesia.The failure rate of epidural anesthesia was comparable between the high anxiety group (NRS ＞ 4) and the low anxiety group (NRS ≤ 4).Conclusions: Preoperative anxiety evaluated by NRS may not be associated with failure of extension of epidural analgesia due to visceral pain during intrapartum cesarean section.(Anesth Pain Med 2015; 10: 271-277)