• Shuzhen Wu, Yaxin Lu, Zijing Zhang, Linjia Zhong, Hongfei Dai, Changping Fang, Minli Huang, Zifeng Liu, and Lingling Wu.
• The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China.
• J Anesth. 2024 Jul 5.

PurposeCombined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia.MethodsThis was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed.ResultsOverall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m2, and those with a primary or secondary education level.ConclusionAppropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia.Clinical Trial Number And RegistryClinicaltrials.gov (ChiCTR2100051809).© 2024. The Author(s).

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