Our reference: YIJOA 2180
P-authorquery-v11
AUTHOR QUERY FORM Journal: YIJOA
Please e-mail or fax your responses and any corrections to: E-mail:
[email protected]
Article Number: 2180
Fax: +31 2048 52799
Dear Author, Please check your proof carefully and mark all corrections at the appropriate place in the proof (e.g., by using on-screen annotation in the PDF file) or compile them in a separate list. To ensure fast publication of your paper please return your corrections within 48 hours. For correction or revision of any artwork, please consult http://www.elsevier.com/artworkinstructions. Any queries or remarks that have arisen during the processing of your manuscript are listed below and highlighted by flags in the proof. Click on the ‘Q’ link to go to the location in the proof. Location in article
Q1
Query / Remark: click on the Q link to go Please insert your reply or correction at the corresponding line in the proof
Please confirm that given names and surnames have been identified correctly.
Please check this box if you have no corrections to make to the PDF file
Thank you for your assistance.
YIJOA 2180 17 April 2013 International Journal of Obstetric Anesthesia (2013) xxx, xxx–xxx 0959-289X/$ - see front matter c 2013 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.ijoa.2013.03.019
No. of Pages 3
CORRESPONDENCE 4 5 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56
Spontaneous presence of partners reduces pain memory during epidural catheter placement Partner presence during labor is now usual.1 It lends support and encouragement to parturients2 and most partners find the experience rewarding.3 In our unit, partners may be present during epidural catheter placement, depending on their willingness and that of the patient, and the permission of the medical staff. We sought to determine if the spontaneous presence of the partner was associated with a decrease in the mother’s severe pain memory during epidural catheter placement, or with a decrease in the memory of anxiety during epidural puncture for both partners. Questionnaires were administered to consecutive and unselected French-speaking laboring parturients and their partners during July and August 2011. All women who had epidural catheter placement were included. Partner presence was defined as the presence of the parturient’s spouse, mother or sibling during labor and delivery. Mothers and partners were given the questionnaire the day after the delivery. Women were asked to rate their pain during epidural catheter insertion on a visual analogue scale (VAS) score from 0 to 10. Partners were asked if they experienced fainting with any related consequences during the same period. Women and partners were asked to estimate their anxiety on a VAS scale and using the state part of the French version of the State-Trait Spielberger Anxiety Inventory (STAI).4 Severe pain memory was defined as a VAS pain score >6, according to the World Health Organization classification.5 For each delivery, the following data were collected: age, parity, gestation, spontaneous or induced labor, mode of delivery, and difficulty with epidural catheter placement. From 1 July to 31 August 2011, for 130 parturients, partners were present during epidural catheter insertion in 84 (65%), and absent in 46 (35%). The main characteristics of the two groups were similar. VAS and STAI scores are presented in Table 1. There was a significant linear trend among the ordered categories of pain during epidural puncture (P = 0.0047), with an average 11% reduction per class of pain severity due to the partner’s presence across the study. Severe pain memory was lower when partners were present compared to absent (15% vs. 39%, P = 0.0025). The anxiety memory scores were not statistically different between groups for either patients or partners. Multivariate analysis showed that severe pain memory was independently associated with partner absence (OR 3.65 [95% CI 1.51–8.82], P = 0,004) and age
www.obstetanesthesia.com
625 years (OR 3.41 [95% CI 1.28–9.08], P = 0.01). Two partners fainted, without consequences. The main finding of our study is that partner’s presence during epidural catheter placement was associated with a decrease in the mother’s pain memory. In most maternity units in France, partners are not allowed by the anaesthesiologist to be present during epidural catheter placement although in our unit, it depends on the willingness of the parties concerned. Orbach et al.6 recently reported that partner presence during epidural catheter insertion did not decrease anxiety levels; on the contrary, anxiety and pain were greater if the partner remained in the room. The discrepancy with our results could be explained by differences in study design; the study of Orbach et al. was randomized and controlled, with restricted inclusion criteria that included nulliparity, term pregnancy and verbal rating score for pain
